What is (are) the clinical sign(s) of hypercapnia? (one or more propositions are true)

This is a sign of struggle. Signs of struggle are: tachypnea, pulling (supraclavicular, sussternal or intercostal), abdominal exhalation and flapping of the wings of the nose. More than their presence, it is their intensity that makes the seriousness of the attack.

This is a sign of bankruptcy. The signs of bankruptcy are: thoraco-abdominal swing, bradypnea (therefore hypercapnia and hypoxemia), neurological involvement (confusion, asterixis), hemodynamic involvement (cyanosis, paradoxical pulse, hypertension).


What is the main infectious agent of winter bronchiolitis, involved in 60 to 90% of cases according to the authors? (one or more propositions are true)


What treatments are not indicated for bronchiolitis?


The duration of treatment for pneumococcal pneumonitis is classically : (one or more propositions are true)


At what age is the first booster of pneumococcal vaccine in children?

Third reminder. The next ones are at 25, 45, then every ten years from 65.


In case of bronchiolitis, what are the systematic complementary examinations?

Non-severe form without sign of severity = no additional examination.


Which of the following germs are responsible for atypical bacterial pneumonitis? (one or more true propositions)

It is not an atypical germ. The picture is close to that of pneumococcus.


In obstructive CKD, the indication for long-term home oxygen therapy is based on the result of 2 blood gas measurements performed at rest, in ambient air, in a steady state, at least 2 weeks apart. Which of the following are indications for long-term oxygen therapy reimbursed by social security? (one or more propositions are true)

PaO2 at 68 mmHg with a hematocrit of 58%

PaO2 is greater than 60 mmHg, so no indication.

PaO2 between 55 and 60 mmHg with the presence of polycythemia (hematocrit > 55%)

PaO2 at 58mmHg with signs of right heart failure

PaO2 between 55 and 60 mmHg with clinical signs of right ventricular failure


What are the 4 germs responsible for post-influenza pneumonia?

The clinic corresponds to an influenza episode followed by worsening after 5-7 days.

It is therefore necessary to initiate active antibiotic therapy on staphylococcus, such as Augmentin or C3G IV.


Reassessment is systematic after 48-72 hours of antibiotic therapy

If worsening or no improvement, look for a loco-regional complication

It is mandatory and systematic to test for HIV for pneumonia, especially if pneumocystosis

No. It is mandatory to PROPOSE screening. This is different

The three nosological entities of bronchopulmonary infections are nasopharyngitis, acute bronchitis, acute exacerbation of chronic obstructive pulmonary disease

Acute bronchitis / COPD exacerbation / CABG


What are the physical signs found classically during a PAC? (one or more propositions are true)

All these signs are markers of alveolar condensation (the alveoli fill with pus from bacteria).


What is lingula? (one or more propositions are true)

The lingula is part of the upper lobe of the left lung. It is located in the caudal (lower) part of this lobe and is ventilated by the lingular bronchus, a segmental (3rd generation) bronchus that branches off from the upper lobar bronchus of the left lung.

It corresponds in a way to the topographical situation of the middle lobe of the right lung. Unlike the right lung, which has 3 lobes (upper, middle and lower), the left lung has only two lobes (upper and lower). This is due to the presence of the heart which occupies a large volume on this side of the rib cage. However, the upper lobe of the left lung is anatomically divided into two subsets.

(According to Wikipedia, content shared without modifications, licensed under CC https://creativecommons.org/licenses/by-sa/3.0/deed.fr)


What are the two treatments of choice for inhalation pneumonitis?

Anaerobes and Enterobacteriaceae should be targeted.


What are the additional examinations carried out on an outpatient basis during a CAP? (one or more true propositions)

Chest X-ray is necessary for the diagnosis of CAP

Unlike legionella antigenuria (which is performed upon hospitalization), pneumococcal antigenuria is reserved for hospitalization in intensive care.


What is the classic clinical presentation of acute bronchitis? (one or more propositions are true)

Which are not synonymous with bacterial superinfection

No crackling, no fireplace. We can have some aspecific bronchial rales.


Which of the following proposals are part of the amoxicillin/clavulanic acid spectrum?

The entire spectrum of amoxicillin (pneumococcus, enterococci faecalis, listeria, meningococcus, borrelia, group 1 enterobacteriaceae) and the addition of a penicillinase-sensitive inhibitor (methicillin-sensitive staphylococcus, haemophilius, moraxella, E. coli, group 2 enterobacteriaceae)

Chlamydia is a bacterium sensitive to macrolides (clarithromycin, erythromycin), tetracyclines, fluoroquinolones

The three families used for the treatment of legionellosis are macrolides, fluoroquinolones, and rifampicin (never monotherapy)


What evidence supports idiopathic thrombocytopenic purpura (ITP)?

the non-infiltrated nature of purpuric lesions

What we do not have in an ITP: organomegaly, abnormality of the blood smear, DIC, Hepatocellular insufficiency, ... Immunological thrombocytopenic purpura (ITP) is an autoimmune pathology characterized by isolated thrombocytopenia of < 100 G / L. It is a diagnosis of elimination, but also the first to evoke in front of isolated thrombocytopenia.

Peak between 2 and 5 years. Second peak, less important, after 60 years.


What tests are unnecessary in the diagnosis of ITP?

True, Table IV, page 291 of the College of Internal Medicine, 3rd edition

Systematic review, with: CBC, Pap smear, PPE, HIV HBV HCV serology, liver test, ANA, Creatinine, PT TCA Fibrinogen, RAI grouping


Mrs. Minerva McGonagall has dyspnea when she puts on her cape but also permanent fatigue of rest. What is its NYHA stadium?

True, dyspnea of rest and for minimal effort.

False, only 4 stages in the NYHA classification.


What is the main risk of seborrheic dermatitis?


In opioid substitution therapy, discontinuation of buprenorphine for pregnancy is not warranted

Buprenorphine can be used regardless of the term of pregnancy

The amount of buprenorphine ingested via milk is too much for the newborn

It is very weak, it can be used during breastfeeding without worry, unlike opiates, which it helps prevent the consumption ;)

Published data in women exposed to buprenorphine during pregnancy are numerous and reassuring

Neonatal opioid withdrawal syndrome is rare with chronic buprenorphine use until delivery

It is common but not serious most of the time


What are the risk factors for pathological bereavement?

Repetition of deaths of loved ones in a short time

True - basically, anything that makes you say "Ouch, this is even worse than I imagined", is worth


A non-smoker has smoked less than 100 cigarettes in his lifetime

The withdrawal period allowed to define an ex-smoker is 6 months

False, commonly accepted time = 12 months

An active smoker is a smoker who has not been weaned for 12 months

An ex-smoker is a smoker who has totally and permanently quit smoking for a certain period of time.


What are the 2 most important questions of the Fagerström test?

Which cigarette would you give up the hardest?

Do you smoke at shorter intervals in the early morning hours than in the rest of the day?

How many cigarettes do you smoke per day?

These 2 questions are the most important because they are the most sensitive and specific, and constitute the simplified Fagerström test.

How soon after waking up do you smoke your 1st cigarette?

Do you find it difficult to abstain from smoking in places where it is prohibited?


Concerning the epidemiology of tobacco consumption

The proportion of smokers increased between 2016 and 2018

The decrease in smoking prevalence is faster among women

Tobacco experimentation is done for the first time around 12 years old


Regarding the physiology of GH, indicate the exact answers:

Secretion is constant and mainly diurnal

The secretion is pulsatile and mainly nocturnal

True, hence the myth (not so mythological as that) that we grow up at night 😊
This myth is also due to the fact that the intervertebral discs decompress at night which makes it possible to gain a few centimeters.

True, produced by the stomach (when we eat, we grow!)

True, produced at the hypothalamic level. It is decreased by somatostatin. According to Wikipedia: Somatostatin, also called GHIH or SRIF, is a protein hormone that inhibits growth hormone. It exists in two active forms, produced by an alternative cleavage of the same pre-protein: one of 14 amino acids, another of 28 amino acids.


Which of the following are sulfonamides?

Analogue of GLP1, like all drugs that end in -tide.

Gliptins are inhibitors of DPP4 (they are, like GLP1 analogues, incretins).


Which anti-diabetic treatments are incretins?

Glinides are insulin-secreting hypoglycemic secretors.

Thomas Marc and Redwane Rakza made an excellent recap:

Insulin-sensitizer:
• Biguanides = Metformin

Insulin secretors hypoglycemic agents:
• Sulfonamides = Gliclazide, Glimepiride, Glibenclamide
• Glinide = Repaglinide

Incretins:
• GLP-1 analogues = Liraglutide, exenatide, dulaglutide
• IDPP4 = -gliptin

A-glucosidase inhibitors:
• Acarbose, Miglitol


What symptoms are adrenergic signs in hypoglycemia?

Adrenergic signs are also those found in stressful situations;)


What are the etiologies of white scintigraphy?

True, the thyroid is homogeneously destroyed

True, the thyroid cannot bind labeled iodine, since its receptors are saturated


What are the etiologies of white scintigraphy with normal TSH and T4L?

Fake thyrotoxicosis by hidden intake of levothyrox


What does not cross the blood-placental barrier?


What are the positive signs of death among the following propositions?


What are the possible complications of high myopia?

Myopic are rather protected from early presbyopia


What is a rupture of the Bruch membrane?

True, another guy who liked his last name too much


What is the definition of iridodialysis?

It is the disinsertion of the base of the iris

This is the rupture of the iris sphincter

It is a rapid increase in the iridocorneal angle


What are the essential documents for the establishment of an ASPDREu?

1 certificate or medical opinion outside the premises

1 certificate or medical opinion within the establishment

2 off-site medical certificate or opinion


The employer has the obligation to reclassify a pregnant woman if she is exposed to certain occupational risks

The employer cannot dismiss an employee during pregnancy

The employer cannot dismiss an employee during the 3 months following the maternity leave

During the month following maternity leave

The pregnant woman is obliged to inform her employer of the pregnancy

No, but it is advisable to do so if there is a need to arrange the workstation

The employer may dismiss a pregnant woman if there is serious professional misconduct. The dismissal then takes effect as soon as protection ends.


Regarding chronic pancreatitis, which propositions are true?

About 80% of heavy drinkers will develop chronic pancreatitis

False, less than 5%. On the other hand, 80% of chronic pancreatitis is linked to excessive alcohol consumption for more than 10 years.

True, by dietary restriction because diet triggers pain

Pain is often present in the early phase of the disease

True, and it tends to disappear in the evolution towards the late phase.

Pancreatic exocrine insufficiency leads to diabetes

False, diabetes is secondary to pancreatic endocrine insufficiency

Exocrine pancreatic insufficiency involves steatorrhea confirmed by a lowered assay of fecal elastase on a stool sample


What are the criteria for poor prognosis for Guilain-Barré syndromes?

True, and always true, regardless of the disease


True, always in real, because limits stiffness and, once the patient is conscious, atrophy


What is the percentage of PRNAI deaths in studies?


What propositions are true regarding lumbar puncture in PRNAI?

Meningitis on Lyme disease or HIV can give a similar picture

Lumbar puncture may show albuminocytological dissociation

True (this is a significant increase in albumin levels while cytology is normal)

There are between 4 and 50 nucleated elements per mL of spinal fluid

There are oligoclonal bands with normal glycorachia


True, because myelin participates in the conduction velocity but not in the amplitude of the signal

Normal amplitudes are found in the demyelinating form

Decreased amplitudes are found in the AMAN form

There is a decrease in conduction velocity


What is just in front of the fourth ventricle?


What are the causes of painful III paralysis?


What does the famous midbrain aqueduct, also called Sylvius Aqueduct, do?

A bit of jokes in this world of bullies 😂😂

Exactly. It connects the 3rd ventricle, which is in the brain, to the fourth ventricle, which is in the cerebellum. To do this, it navigates to the posterior part of the midbrain.

It connects the occipital lobe to the cerebellar hemispheres

It connects the vermis to the cervical marrow


What is the definition of a tonic crisis?

Repetitive and rhythmic segmental muscle twitches

Contraction of agonist and antagonist muscles, alone or in bursts


What is the definition of a myoclonic crisis?


Which of the following are true about herpetic meningoencephalitis? (one or more propositions are correct)

It is exceptional in an immunocompetent subject

Quite common (in the rarity of meningitis): this is the first cause of clear fluid meningoencephalitis.

Treatment is based on IV aciclovir for 5 days

T1 and T2 hyposignals are found on temporal MRI


➡ By temporal lobe injury: Herpetic meningoencephalitis +++

Hypersomnia is found in Kleine-Levin syndrome, of unknown cause.


We often hear that clear fluid meningitis is not serious. Nevertheless:

40% of patients will have neuropsychological sequelae

The causative agent is not found in one out of two cases

No, 25% are related to HSV, remember that 90-100% of adults are infected with HSV


Which of the following are signs of seriousness requiring hospitalization in intensive care in case of meningitis? (one or more propositions are correct)

It's called a purpura fulminans, it falls every year, and it's the only thing that can take you to court as an outsider if you don't think about it. All right? 0:)

All meningitis is managed in intensive care

Benign viral meningitis is usually managed on an outpatient basis. Bacterial meningitis can be managed in conventional medicine, intensive care unit, or intensive care.

Thrombocytopenia with platelets below 100G/L


What are the notifiable etiologies of meningitis or meningoencephalitis?

Syphilis has been a long time since 😊 OD

The complete and up-to-date list is available here: https://www.santepubliquefrance.fr/maladies-a-declaration-obligatoire/liste-des-maladies-a-declaration-obligatoire


What elements are part of the semiology of autoimmune encephalitis?

Yes, they are also called limbic encephalitis because they mainly affect the internal temporal lobe (so also give visual hallucinations, such as frontotemporal dementia :) )


Which of the following proposals promote invasive pneumococcal disease? (one or more propositions are correct)

Sickle cell disease is a cause of functional asplenia by multiple spleen infarction leading to either splenic sequestration of immune cells or cessation of their splenic production/maturation

Only the cochlear implant is a risk factor


The allowance for the supervision of a disabled child (AEEH) is allocated by the MDPH

ADHD is statistically linked to the occurrence of OCD and ASD

TBI (conduct disorder) and/or OD (Defiant Opposition Disorder) can be found in children
In adults, there is an increased risk of other pathologies such as mood disorders and delusional disorders, but this is outside your program.

Methylphenidate is the standard drug treatment for ADHD

Yes, it is an amphetamine derivative prescribed on secure prescription for 28 days, with a prescription limited to certain professionals: psychiatrists and child psychiatrists, neurologists, and pediatricians

Educational assistance in an open environment is provided at the parents' home, at home


Not necessarily, but at least moderate, because a history of TS is a major FdR of suicide, so increases the R


Delusional idea, often present in melancholic depressions


Regarding generalized anxiety disorder (GAD):

Frequency is higher in men than in women

We can find difficulties of an intellectual nature

It's hard to perform intellectually when you're anxious, remember your last staff presentation...

Anxiety is anticipatory between paroxysmal episodes

There are no paroxysmal episodes. Anxiety is continuous, not associated with identified triggering events, excessive and uncontrollable.


Everything is true except sputum (page 78 of the pneumo college).


What is the definition of RPM (premature rupture of membranes)?

Rupture of membranes occurring before the start of labour

Rupture of membranes occurring before release

It doesn't make too much sense, right? 😅 How can the baby get out without breaking the membrane?

Rupture of membranes occurring before engagement

Rupture of membranes occurring for more than 12 hours before delivery

Rupture of membranes occurring for more than 24 hours before delivery


Regarding eyelid pathologies, what are the exact proposal(s)?

A stye usually manifests as a painful pustule, centered on an eyelash.

Chalazion usually manifests as inflammation of the Meibomus gland

True, this is the definition of chalazion

Chalazion or stye does not cause decreased vision

Blepharitis or dacryocystitis is a differential diagnosis

Treatment of chalazion is based on antibiotics


Regarding acute pancreatitis, which propositions are true?

Acute pancreatitis is a common digestive emergency

The most common form of acute pancreatitis is acute necrotizing pancreatitis

False, 80% of cases of acute pancreatitis are benign and are described as edematous

They may be accompanied by vomiting related to a reflex ileus

Lower myocardial infarction may be a differential diagnosis of acute pancreatitis

Diagnosis is based on a combination of suggestive abdominal pain and lipasemia > 3N


Which of these proposals are not risk factors for peptic ulcers? (three proposals expected)

It is indeed a risk factor for ulcers. Other risk factors to be aware of are: H. pylori, NSAIDs and Aspirin, Zollinger-Ellison Syndrome, genetic predispositions and certain vasculitis

Gastrinoma 👉 gastrin 👉 hypersecretion decrease in pH (which therefore becomes more acidic) 👉 multiple and recurrent ulcers


Acute gastritis due to H. pylori is most often: (only one response expected)


Zollinger-Ellison syndrome is secondary to:

It is an endocrine tumor that lowers the pH of the stomach and can cause recurrent postbulbar multiple ulcers.


In what proportion of cases, on average, does H. pylori infection progress to acute gastritis?

Almost all HP infections progress to acute gastritis


Zollinger-Ellison syndrome is accompanied by a: (only one expected response)


Which gastritis are at risk for gastric adenocarcinoma?

Only atrophic gastritis is at risk of gastric adenocarcinoma

Biermer's disease (autoimmune atrophic gastritis)


An ulcer, by definition, reaches up to: (only one expected response)


What is the preferred location of H. pylori in the stomach? (only one answer expected)


H. pylori infection in childhood occurs mainly by: (only one response expected)


In addition to evacuative punctures, the treatment of ascites is based on:

to avoid because promotes undernutrition

Spironolactone, or even furosemide in case of insufficient response

True, to decrease gradually when ascites is controlled, until a complete stop. To be resumed if ascites reappears.


In xxx of the cases, cardiocirculatory arrest is related to a ventricular rhythm disorder. xxx corresponds to:


What are the different clinical signs of struggle to look for in favor of ARD?

Recruitment of accessory respiratory muscles

= Suprasternal, supraclavicular and intercostal draw

Not to be confused with signs of bankruptcy:
- Paradoxical abdominal breathing (= thoraco-abdominal swing);
- Hypoxemia with cyanosis;
- Hypercapnia with neurological impact (G < 15)


What advice should I give to patients with pneumothorax?

For flights in pressurized aircraft, a delay of 2 to 3 weeks is recommended after a PNO

without, however, formal proof of this period

definitive contraindication of diving if detection of bullous lesions in spontaneous PNO ATCD lengths


What are the treatments of a coronary patient after revascularization of an ST+ SCA?

Not indicated: we are talking here about the famous C-BASIC ☺


Regarding Ring and Meisner's classification:

Grade II = Mucocutaneous signs (urticaria, angioedema)

Grade III = Moderate multi-organ involvement (mucocutaneous signs, respiratory tightness, tachycardia, hypotension < 20 mmHg)

Grade IV = Severe multi-organ disease (respiratory distress, severe bronchospasm, laryngeal oedema, collapse, bradycardia)


What signs are in favor of a hypovolemic cause?

polytraumatized with abdominal pain and defense


What are the clinical signs consistent with heroin poisoning?

Hypotonic calm coma. Tight miosis. Bradypnea. This is common to benzodiazepine or opioid poisoning (such as heroin).
Conversely, SSRIs/Tricyclics/Atropine/Cocaine/Amphetamines cause restless coma with mydriasis, hypertonia and ROT vivid


The hemodynamic profile of a severe burn is close to shock:


It's 4am and you're called by internal medicine for a 50-year-old patient, with chronic alcoholism being weaned improvised by the patient.

The patient has rapidly deteriorated neurologically (GSC 4), he presents with respiratory failure with PaO2 52 mHg pCO2 60.

On biology you note:
- Hb 7 g/dL, VGM 93 fL,
- Platelets 25 g / L,
- Schizocytes with a smear,
- LDH 245, collapsed haptoglobin,
- Acute renal failure with serum creatinine 235
- Normal vitamin B12, slightly decreased B9

You take him in intensive care and do the necessary resuscitatory measures
At D+2, while you are trying to lift the sedations to assess neurological functions, the patient has a seizure

TRUE. Mechanical hemolytic anemia with thrombocytopenia and acute renal failure + neurological picture. So it's quite possible!

A dosage of complement and ADAMTS13 is relevant

TRUE! - Supplement to know if it is consumed or not (especially in atypical HUS): mutations will cause endothelial lesions by deposition of pieces of supplements that wander.

- ADAMTS13 is a metalloprotease that cleaves the Willebrand factor that wanders in small pieces in the microcirculation of organs. The problem... it is that these small pieces of Willebrand factor attach the platelets nearby --> Obstruction of the lumen of the vessels

Thrombotic microangiopathy is characterized by obstruction of the lumen of capillaries and arterioles

HUS is characterized by a neurological picture in the 1st plane

TTP is characterized by a neurological picture in the 1st plane


What is found in the laboratory workup of primary hyperparathyroidism?

True, phosphatemia is low because PTH decreases phosphate reabsorption

True, because it is adapted to hypercalcemia caused by primary hyperparathyroidism

False, in primary hyperparathyroidism, serum calcium is elevated


What disorders of phospho-calcium metabolism can be found in chronic renal failure?

False hypocalcemia leading to secondary hyperparathyroidism

True, by decreasing renal excretion of phosphates


What can be the heart damage of chronic renal failure?


The CKD-EPI and MDRD formulas take these factors into account:

False, it is the Cockcroft that takes into account the weight. Cachexia or obesity are not factors that are taken into account for the calculation of GFR by the CKD-Epi or MDRD formulas

False, for the same reason that weight is wrong


What are the arguments in favor of an AKI in the face of elevated serum creatinine?

Normochrome normocytic aregenerative anemia

False, rather in favor of CKD except in the case of hemolytic uremic syndrome or hemorrhagic shock


What parameters are taken into account in the calculation of GFR by the CKD-PPE formula?

False, not used for MDRD and CKD-PPE, but it is used in Cockcroft and Gault's formula


What CKDs can occur with large or normal sized kidneys?

False, cause of acute renal failure with anemia


In which cases can I have CKD without hypocalcemia?

False, gives rather CKD with large kidneys but with hypocalcemia


In which cases is it not possible to estimate GFR by MDRD and CKD-PPE?

True, use of Schwartz's formula up to about 15 years (the exact age varies in practice depending on the morphology)

In a subject with decompensated hepatic cirrhosis

This situation is conducive to acute renal failure (first functional and then organic if not managed) which makes the calculation of GFR not recommended

True, because significant muscular atrophy

The GFR is physiologically changed in pregnant women, the calculation by these formulas will find an underestimated result


What are the causes explaining, between them, 80% of hypercalcemia?


Edema are markers of extracellular hydration status (HEC: extracellular hyperhydration). Since natremia is an indicator of intracellular hydration status, it is not influenced by the absence or presence of edema.

Is increased in case of intracellular dehydration

Is decreased in case of intracellular dehydration

Provides information on extracellular osmolarity

Indeed, to calculate the extracellular osmolarity, the formula is used: Osm = 2Na + Glucose (normal: 285 mOsm / L)


False, is not responsible for ketoacidosis


What abnormalities are in favor of ketoacidosis?

False, the urinary anion hole is not used during metabolic acidosis with indosed substances

False, the plasma anion hole is increased


Which blood gas elements support hyperchloremic metabolic acidosis of tubular origin? (one or more exact propositions)

False, it is negative when the origin is digestive. Here the urinary anion hole must be positive

False, PCO2 in metabolic acidosis is decreased to compensate

False, bicarbonate is decreased in metabolic acidosis

True, the pH to be in acidosis must be less than 7.38


Are signs of hyperkalemia on ECG: (one or more exact proposals)

The pointed head (pointed T waves) of the grandfather (elongation of the PR) widens the priest (widening of the QRS) without his fart (disappearance of the P wave).


Water constitutes about X of the weight in an adult: (one or more exact propositions)


Regarding proximal tubular acidosis type 2? (one or more exact propositions)

It is due to a defect in proximal secretion of bicarbonates

False, proximal tubular reabsorption defect of bicarbonates

We can find phospho-gluco-amino diabetes

False, it is low and is aggravated by the contribution of alkaline


What are the abnormalities found in respiratory acidosis being compensated? (one or more exact propositions)

False, decreased bicarbonate in metabolic acidosis


Which of the etiologies responsible for hypotonic hyponatremia (< 285 mOsm/L), which is (are) associated with a normal extracellular hydration state? (one or more exact propositions)

The extracellular compartment is increased, with the presence of edema, ascites, pleurisy, pegardic effusion, etc.

The extracellular compartment is decreased. We have dehydration (skin fold, hypotension, tachycardia, ...)

These are the three causes to know hyponatremia (Na < 135) hypotonic hypotonic (Osm < 285) with normal extracellular sector (no edema, no skin fold).


A repetitive discharge of muscle fibers (in a muscle disease) or neurons (in epilepsy) can be caused by several situations. Which? (one or more exact propositions)

To be in a situation of repetitive discharge, the membrane potential must increase. So whether there is an exit of the anions, or an entry of the cations (to go from -70, i.e. the basic membrane potential, to a higher potential). So we want to open the K+ channels, lower the operation of the Na+/K+ pump, close the Cl- channels.

True. If the K+ channels no longer open, the K+ remains in the cell and increases the membrane potential

If the K+ channels remain open, all the K+ will come out, there will be much fewer cations in the cell, the membrane potential will decrease

True, the lower the Cl- enters, the less the membrane potential decreases.


How to tell the difference between potomania and diabetes insipidus? (one or more exact propositions)

If diabetes insipidus is peripheral, it's not going to change anything

True. If polyuria stops: potomania. Otherwise: diabetes insipidus.


What changes can lead to membrane hyperpolarization? (one or more exact propositions)

The opening of the Na+ channels causes Na+ to enter the cell, which participates in depolarization.

True. Hyperpolarization is an increase in the absolute value of the membrane voltage = the membrane potential becomes super negative. In general, a normal resting potential is considered to be around -70 mV. For it to decrease even more, it is necessary: either that there is an exit of cations (i.e. K+ or Na+) or that there is an entry of anions (i.e. Cl-). For potassium to leave the cell, there must be an opening of the K+ channels (the ions come out on their own because they are much more concentrated in the cell than outside). For the Na+ to come out, the Na+/K+ ATP pump must work more (it brings out Na+ to bring in K+).

The anions (chlorine) would have to enter the cell to increase the anions and thus lower the membrane potential, making the cell hyper-polarized


What are the signs of intracellular hyperhydration? (one or more exact propositions)

It is a sign of extracellular hyperhydration


You receive in consultation Mr DESBOIS Robin, 76 years old, who describes himself as a "bon vivant". He limps when he arrives at your consultation and has his right foot bare. He says that the pain started in the middle of the night, and that since then he throws him, whether he walks or not. You examine it and brilliantly diagnose a first attack of gout on the 1st metatarsophalangeal, which you treat just as well. You see him again two weeks later at your consultation, to talk to him about the rest. What are the real propositions? (one or more exact propositions)

In this patient, you need to wait for 2 gout attacks before introducing treatment

False, hypouricemic treatment is introduced at the first gout attack

Foods rich in uric acid are organ meats and seafood

True, foods rich in purines and suppliers of uric acids are organ meats, brewer's yeast, seafood, tea, strong alcohol, sodas and beer even without alcohol.

This patient is advised to stop beer, but he can continue non-alcoholic beer.

If treatment is introduced, the uric acid target will be 70mg/L

The target is 60mg/L one of the few standards that we must know by heart!

In this patient we will choose Allopurinol or Febuxostat as background treatment

True, these are the two background treatment options


You have introduced a background treatment with ALLOPURINOL, and you explain to the patient the side effects of this treatment and in particular serious side effects, requiring a consultation in the emergency room. Which of the side effects described below may be attributable to ALLOPURINOL? (one or more exact propositions)

True, there is a concern for a serious allergic reaction during treatment with ALLOPURINOL. These are not the only side effects (neutropenia, digestive disorders), but they are essential to remember


In which cases may alpha-1-antitrypsin be indicated? (one or more exact propositions)


What non-drug measures are indicated for the treatment of COPD? (one or more exact propositions)


What are the differential diagnoses of COPD? (one or more exact propositions)


Which antibiotics are used as a 1st line in an exacerbation of COPD? (one or more exact propositions)

Reserved for special cases, not systematic


What are the possible treatments for COPD? (one or more exact propositions)


What results of EFR can be found in COPD? (one or more exact propositions)

False, rather found in asthma which is a reversible TVO

CPT> 120% defines chest distention, possibly found in COPD


What is the systematic screening offered for any pneumonia? (only one answer expected)


What are the 3 criteria for hospitalization of bronchiolitis? (HAS 2019, included in the College of Pediatrics 2021)

respiratory rate greater than 30 per minute

No cut-off for respiratory rate in 2021 College of Pediatrics

No cut-off for heart rate in 2021 College of Pediatrics


What germs can cause community-acquired acute pneumonia? (one or more exact propositions)


From what age can we no longer talk about bronchiolitis? (only one answer expected)


What are the four different causes of excavated pneumonia?

It is a fungus of the sweet name of Histoplasma capsulatum


What are the two treatments of choice for a CAP by superinfection of influenza?


What are the 3 entities of adult community lower respiratory infections?


What clinical signs support acute bronchitis? (one or more exact propositions)

Their absence is an important negative sign

No dyspnea, no physical signs usually apart from fever and viral symptoms


What is the probabilistic antibiotic combination of choice in ICU/REA of a CAP in a non-immunocompromised patient? (only one exact answer)

This is a relatively useless combination since it covers the same germs

This combination targets P. aeruginosa. It is therefore only put in place in case of risk factors (bronchiectasis, bronchial dilation, cystic fibrosis, immunosuppression, ...)

Cotrimoxazole is added for immunosuppression only.

It is the antibiotic of choice for the elderly (outpatient or hospitalized)


What are the treatments for acute bronchitis in healthy adults? (one or more exact propositions)


What are the criteria for CRB 65? (one or more exact propositions)


What consequences can chronic respiratory failure have? (one or more exact propositions)

Chronic hypoxemia is compensated by polycythemia that leads to blood hyperviscosity and an increased risk of thrombosis

Declated oedema due to fluid retention attributed to an abnormality in the regulation of natriuretic factor or as a result of pulmonary hypertension

Due to decompensation of chronic respiratory failure


What etiologies of chronic respiratory failure are RVCs? (one or more exact propositions)

Mixed disorder: restrictive and obstructive


Which etiologies of respiratory failure are mixed ventilatory disorders? (two answers expected)


What are the main causes of exacerbation of chronic respiratory failure? (one or more exact propositions)

The 3 main causes of exacerbation to look for:
- Lower respiratory infections: pneumonia, bronchitis
- Dysfunction of the left ventricle (pulmonary edema) and rhythm disorders
-Pulmonary embolism


What are the treatments for chronic respiratory failure? (one or more exact propositions)


Which of the following conditions are etiologies of acute dyspnea (and not chronic dyspnea)? (one or more exact propositions)

Obstruction of the upper airway by a foreign body


What is the prevalence of asthma in adults in France?


What is the proportion of disharmonious IUGR?

This is the proportion of IUGR harmonious


Is done on ultrasound by quantifying amniotic fluid

Is done with Doppler of the uterine arteries

Looking for an increase in placental resistance

Looking for brain sparing secondary to hypoxia


How many AS is Rophylac injected in Rh- patients?

Rophylac aims to prevent immunization of Rh- mothers against Rh+ fetuses (among others). It is therefore never offered to Rh+ patients, who cannot be immunized against the Rh antigen, since they are constitutionally carriers of it.


What is the prevalence of premature rupture of membranes (RPM)?


What antibiotics is Listeria naturally resistant to?

Acquired resistance to L. monocytogenes is exceptional


Which of the following treatments are nephrotoxic?

True, just like cyclosporine, immunosuppressants have an effect on kidney vessels and tubules.

True, THE anti-cancer treatment that causes tubulopathies. Do not forget other treatments that can be nephrotoxic such as Methotrexate, Gemcitabine or Mithomycin C

True, more than classic, overall you can forget the NSAIDs that give vascular, interstitial and glomerular damage

True, very classic case of tubular toxicity!


Fluindione is no longer given as a first-line treatment

It is no longer administered at all, EXCEPT in patients who are already on fluindione and who are stable.

INR measurement reflects the dose ingested 3 to 5 days in advance

This is the time it takes for the liver to make clotting factors.

Vitamin K antagonists have many drug interactions

Renal failure is a contraindication to VKAs


Tramadol is a molecule with both opioid properties (by acting directly on mu receptors) and pro-norepinephrine/serotonin. It can be combined with paracetamol.

Nephopam, like NSAIDs, nalbuphin and paracetamol, are level 1 analgesics.

Lamalin, for example, is a specialty that includes opium and paracetamol.


What are the side effects of corticosteroids?

It is a cause of hypercalciuria with normal serum calcium


Sulphonylureas stimulate insulin production

They stimulate its secretion! And it's not the same 😬

Sulfonamides stimulate insulin secretion

Metformin is an insulin-sensitizer. It does not work in the pancreas. This is why there is no risk of hypoglycemia

SGLT2 inhibitors are contraindicated in renal impairment with GFR < 70

They are contraindicated from a GFR < 45 (nasty trap, I admit... but useful! You won't forget it now!)


If transaminase levels are above three times normal, statins should not be introduced

Iatrogenic diabetes is one of the side effects of statins

Statins should not be used at the same time as fibrates

They are monitored under fibrates, if the patient complains of myalgia

The second-line anti-lipidemic is the PCSK9 inhibitor

This is ezetimibe, which is a therapeutic alternative in case of intolerance to statins.


Side effects of potassium-sparing diuretics include:

Overall, we can remember that H+ ions (which acidify the blood) go where potassium goes (it's very schematic, but it works 😉)


During an accident of anticoagulants (hemorrhage under VKA with very high INR), the administration of vitamin K acts by:

Unlike CCP infusion which acts immediately. It is therefore necessary to control the action of the latter about 30 minutes after the end of the infusion by an INR assay.

Vitamin K administration has no place in the management


What is the pre-therapeutic assessment of direct oral anticoagulant anti-IIa (dabigratran)?

We will not give it if its hemoglobin is at 5 😅

We will not give it if its TCA is at 5 😅


The contraindication(s) of B-blockers is:


Which of the following combinations Adverse reaction - Inducer drug(s) are accurate?

True, this is why we do an ECG in psychiatry before administering psychotropic drugs!

False, allopurinol on the other hand is at risk of hepatitis and allergic reaction!

True, just like statins, fibrates are also at risk for rhabdomyolysis

True, one of the most well-known side effects!

Syndrome de Lyell/Stevens Johnson - Lamotrigine

True, lamotrigine is a very allergenic treatment


You receive in consultation, Mr BRISANCHOYEUR, Archibald, 54 years old, in whom you prescribe for the first time morphine. As a result, you make a prescription for narcotics. What are the particularities of this order?

The prescription period is usually 28 days, but it can be 14 days or 7 days

If the new order is drafted before the end of the period covered by the previous one, it is therefore null and void.

False, it will be in addition to the previous ordinance

The overlap of two prescriptions is possible for a shorter period of 3 days


Regarding adverse drug reactions and pharmacovigilance, what are the exact answer(s)?

Immuno-allergic side effects are most often predictable

False, it is the opposite, they are usually unpredictable because allergies are never predicted in advance.

DRESS syndrome is a bullous rash secondary to medication

False, it's Lyell syndrome! DRESS syndrome is manifested by erythroderma with eosinophil infiltration

The declaration of adverse drug reactions is done on the ANSM website

False, it is carried out on the website of the CRPV (regional pharmacovigilance center) which transmits the notifications to the ANSM which, it, will evaluate the notifications

Almost half of the medicines sold on the Internet in Europe, apart from legal sites are fake

True, a point that reminds us that counterfeit medicines are a global scourge, with very lucrative markets...

If the damage related to a medical accident due to the therapeutic hazard exceeds 24%, the patient will be compensated by ONIAM

True, from the College of Pharmacology and Public Health


Melting Pot n°2! Which of the following proposals concerning pharmacology are true?

Patients can report adverse drug reactions online

True, essential information that often falls into MCQ

One of the quality criteria of an ordinance is its computer writing and not its handwritten writing.

True, very logical when we see the hieroglyphs of some

3% of hospitalizations are due to adverse drug reactions

True, small epidemiological figure that is good to keep in mind

The MIC of antibiotics is the maximum inhibitory concentration, which is equivalent to its bactericidal or bacteriostatic effect

False, the MIC is the MINIMUM inhibitory concentration, the lower it is, the more powerful the antibiotic is and allows to define if the bacterium is sensitive, intermediate or resistant

Prescription of unfractionated heparin leads to pharmacokinetic monitoring

False, it is a dosage of activity, anti Xa activity so a pharmacodynamic monitoring


Melting pot! Which of the following proposals concerning pharmacology are correct?

False, this is a pharmacodynamic follow-up. Pharmacodynamic monitoring aims to see the effectiveness of the treatment while pharmacokinetic monitoring aims to see the concentration of the drug

The equilibrium dose is usually reached at 5 half-lives

True, this is the commonly accepted dose of equilibrium

The prescription of oral NEFOPAM as an analgesic is an off-label prescription

True, this is one of the best known off-label prescriptions. If you look in VIDAL you will not find an oral dosage.

The use of certain psychoactive drugs must be declared to the ANSM

False, it must be declared to the regional pharmacovigilance centre

WHO's list of essential medicines is updated every 5 years


What are the risk factors for child maltreatment?

False, the Baby Blues is physiological and does not lead in any case to an excess risk of abuse unlike postpartum depression

A history of childhood abuse in one of the parents

True, as is often said, parents reproduce what they went through together.

False, trap, abuse affects all social classes without exception

Addiction to a psychoactive substance in one of the parents

True, do not forget alcohol and nicotine, which can be the cause of abuse

True, a separation at birth, or a complicated end of pregnancy increases the stress of the couple and can be the cause of abuse


Regarding child abuse, what are the exact answer(s)?

A fracture in a child of non-walking age is abuse until proven otherwise

True, great pediatric adage, always have it in mind.

Dropping out of school can be a sign of abuse

True, we often see a sharp break in academic results.

Legally, it is mandatory during the consultation to have the adult always in the company of the child

False, the doctor (even general practitioner) can see the child alone if he wishes

In case of strong suspicion of ill-treatment with alleged perpetrator in the child's home, information of concern must be sent to the CRIP

False, in this case, the life of the child is in danger and the doctor must, for the survival of the child, contact the hospital and make a report to the public prosecutor.

The physician may be liable if he or she directly or indirectly names the alleged perpetrator of the abuse

True, never name someone or their role (father, mother) in a certificate, mark "the aggressor"


What should lead to the prescription of a microsatellite instability test?

Multiple synchronous cancers of the Lynch syndrome spectrum in the same patient

Multiple metachronous cancers of the Lynch syndrome spectrum in the same patient

The three things to know are:
- Colorectal cancer < 60 years,
- Multiple cancers (synchronous or metachronous) of the Lynch syndrome spectrum in the same patient,
- Colorectal cancer + family history of Lynch syndrome spectrum cancer (at least one first-degree relative< 50 years or two related, first or second degree relatives, regardless of age)


The most common histological type in breast cancer is:


Cisplatin:
- hematological toxicity
- nausea/vomiting
- peripheral neuropathy
- kidney damage
- ototoxicity
no alopecia (cyclophosphamide, irinotecan, anthracycline, etoposide, paclitaxel, docetaxel, 5FU)
no hand-foot syndrome (anthracycline, docetaxel, 5fu, capecitabine)
no diarrhoea (oxaliplatin, irinotecan, anthracycline, paclitaxel, docetaxel, 5FU)
no cardiac involvement (anthracycline and 5FU)
no skin necrosis if extravasation (antracycline)


Cancer is the leading cause of death in France

Cardiovascular diseases are the third leading cause of death in France

Cancer incidence higher in men than in women

Cancer is still a predominantly male disease

Cancer mortality rises steadily for both men and women

Cancer incidence is 0 before the age of 5


What is the global incidence of cancer in 2018?


What is the global mortality of cancers in 2018?


N < 1.3 (or 1.4 depending on the source)


Which of the following leads will show an elevation in a high outboard SCA ST+? (one or more exact propositions)


What is the molecule of choice to slow down poorly tolerated atrial fibrillation (OAP) in acute?

Calcium channel blockers are contraindicated in heart failure (whether acute or chronic)

None, do not slow down atrial fibrillation since the patient is in OAP

On the contrary, the patient is in OAP because the left atrium contracts too quickly and uncontrollably for the atrial systole to be effective. The heart rate needs to drop so that the mitral valve stays open longer, so that blood has more time to pass into the left ventricle.


Which cardiovascular risk factors are modifiable?

Non-modifiable cardiovascular risk factor

Alcohol is not a cardiovascular risk factor!


Angiotensin II: (one or more exact proposals)

Stimulates adrenal release of aldosterone


This hormone is released by the hypothalamus into the pituitary gland

This hormone stored in the pituitary gland

This hormone is the main hormone regulating blood pressure

This hormone can be released inappropriately

This hormone can cause hypertonic hyponatremia

Hypotonic hyponatremia (plasma osmolarity < 285)


What are the side effects of beta-blockers? (one or more exact propositions)

Active asthma is also a contraindication


Which of the following diuretics is not contraindicated in chronic renal failure with GFR < 30? (one or more exact propositions)


Your patient, Roberta, 62, comes to your office smiling. She feels very well and has no history other than high blood pressure that you brilliantly diagnosed several months ago. It is under ACE inhibitor (ACE inhibitor) and calcium channel blocker (CI). However, its last blood pressure self-measurement that it presents to you is at 146/89 mm of mercury. How do you adapt the treatment in this patient in order to balance her high blood pressure? (one or more exact propositions)

Maintaining the same treatment, it will settle down over time

Not conventionally used in hypertension, except for example in cases of renal failure and heart failure.

Addition of a central antihypertensive drug

Only considered after trying triple therapy containing thiazide


What elements are found in the Kirkendall classification (hypertensive retinopathy)?


What are the adrenal pathologies associated with hypertension?

We do not see this pathology at the ECN! This is congenital adrenal hyPERplasia

It is a pituitary pathology and not adrenal (as the question asks)


Where is renal sodium reabsorption most important?

Nearly 70% of reabsorbed sodium is reabsorbed at the beginning 😉

I admit that we were not very inspired for the last proposal 😬😬


What are the signs visible on chest X-ray when heart failure is suspected?

Cardiomegaly, defined as a cardiothoracic ratio (RCT) > 0.5.

A vascular redistribution from the vertices to the base.

An interstitial syndrome with Kerley B-lines.


What are the additional tests to be performed when heart failure is suspected?

NFS, blood ionogram, serum creatinine, liver test, TSH, serum iron, ferritin, CST.


What are the possible complications of DVT?

Possible via a permeable foramen oval. This is called a paradoxical embolism


What is the balance sheet of a secondary Raynaud?

These are the two systematic complementary reviews.


In what type of tachycardia can we see a pre-excitation delta wave and a short PR space < 120 ms?


Until proven otherwise, any regular tachycardia with wide QRS is:

False, there is regular tachycardia with fine QRS but we always think first of ventricular tachycardia.

False, anarchic rapid ventricular activity.


Until proven otherwise, any irregular tachycardia with fine QRS is:

In the AM, there is a tremulation of the baseline.


What are the etiologies of primary mitral insufficiency among those proposed below?

Chronic left ventricular remodeling post-infarction.


What propositions are true regarding the epidemiology of infectious agents? (one or more propositions are true)

Enterobacteriaceae are the bacteria most often found in community urinary tract infections

Like E. coli, Klebsiella, Proteus mirabilis, etc.

Meningococci are the bacteria most often found in bacterial meningitis in a 30-year-old adult

Meningococcal = 18 to 25 years. After that, it's pneumococcus.

Meningococci are the bacteria most often found in bacterial pneumonia

Meningococci are not involved in pneumonia at all.

Listeria is the bacteria most often found in pneumonia after age 50

Listeria is found mainly in meningitis after 50 years

Staphylococci are frequently found in post-influenza pneumonia


Which of the following proposals may be responsible for genital ulceration? (one or more answers are correct)

Oral and genital canker sore is characteristic

Gonococcus gives high STIs or ervicites with urethritis, yellow-green purulent leucorrhoea, urination burns, etc. No ulcerations at the rendezvous

The primary chlamydia lesion is usually genital site with small, non-indurated papule, often erosive, painless, rapidly limiting. Sound like syphilis? Is it a potential differential diagnosis:)


Which of the following are causes of TPHA- / VDRL+? (one or more answers are correct)


Which of the following are characteristic of trichomonas? (one or more answers are correct)


What are the risk factors for urinary tract infection in women?

A priori, women do not have a prostate 🤭 (sorry for the trap, but it is important to read the statements. Often, in the annals, we make stupid mistakes because we did not read the question correctly)


only the distal urethra is colonized by perineal flora

Hematogenous infection is the main cause of cystitis

It is rather an ascending infection ++ from the distal urethra

Being a woman, especially postmenopausal, is a risk factor for UTI

All causes of obstructive uropathy (BPH, stenosis, cancer) are risk factors


Positive hematuria if > 10^4/mL = 10/mm3


Which antibiotics are effective on EBLSE-producing beta-lactamase-producing enterobacteriaceae? (four proposals expected)

Beta-lactams do not work (except Piperacillin-Tazobactam, Carbapenem and Cefoxitin)


And especially S. saprophyticus (young woman)

Aerobic BGN does not produce it, most often


How long is treatment with Pivmecillinam?

This is the probabilistic second-line treatment for simple acute cystitis. No systematic follow-up consultation (only if the patient's need is felt)

In simple acute cystitis, there is never ECBU


The control of the negativation of the ECBU is indicated in case of:


What is the pathology that does not require ECBU?


S. saprophyticus is naturally resistant to: (only one response expected)

First-line treatment in young women with nitrite negative


The sex ratio is in favor of women F >> H

1/3 of women will have a urinary tract infection

recurrent if there are more than 3 episodes per year

More than 4 episodes per year (more than one every 3 months). Severe if more than one episode per month.


What are the 3 clinical forms of cystitis to identify in order to adapt the management?

3 notions to remember and differentiate. The care follows directly from this:)


What is the only mandatory examination to perform in case of simple hyperalgic NAP? (apart from BU and ECBU)

If risk of complications, at a distance from the episode

Only done if there is a diagnostic doubt


What are the two indications to treat asymptomatic bacteriuria?


What are the four causes of aseptic leukocyturia?

We will rather find a microalbuminuria in case of significant 😊 renal damage


Before any ATB, after a peritoneal toilet, in non-sterile condition, 4 hours after the last urination, and in the middle of the jet

We don't really have an idea for the fifth proposal 🤷 ♂

The main thing is to remember that it is not at the beginning of the jet, unlike the samples for sexually transmitted 😊 infections (it is on this notion that you can be trapped)


Regarding cyclines, which proposals are true?

They have an almost complete absorption orally (PO)

They are contraindicated during pregnancy

Doxycycline is used to prevent malaria. It is taken 1x / D during the stay and 4 weeks after the return.

They work by inhibiting protein synthesis


Concerning the neu
Regarding febrile neutropenia:
Regarding febrile neutropenia:

Regarding febrile neutropenia:

It is defined by neutropenia (PNN < 500/mm3) or fever.

The digestive tract is the majority gateway.

True, then skin, central venous catheters and lungs.

The clinical examination is often rich in clinical signs.

False, often poor because no inflammatory focus.

Central venous catheters promote infections.

Chest X-rays often show a focus at the onset of fever.

False, 40% of neutropenic patients with pneumonia have a normal chest X-ray at the onset of fever (see PILLY p 327).


What are the 3 therapeutic emergencies? What are the 3 therapeutic emergencies?


Which of the following are viruses that can cause encephalitis? (one or more propositions are correct)

HSV1 > HSV2. Involvement occurs mainly in the temporal lobes

He has diarrhea. 💩 Enteroviruses can cause meningitis


Which of the following proposals are part of the semiology of herpetic meningoencephalitis? (one or more propositions are correct)

Progressive onset of symptomatology in 15 days


Which of the following proposals corresponds to the meningococcal serotype mainly responsible for meningitis? (only one exact proposal)


What should we mention if urticaria in return from tropical travel?


What is special about colonic amoebosis?

True, unlike hepatic amoebosis. Treatments, clinical presentation and prognosis differ


What additional examinations do you want to perform in front of a torsion of the spermatic cord?

Given the urgency of torsion of the spermatic cord, no additional examination is necessary, unless there is a diagnostic doubt


How quickly should testicular torsion be treated?

Torsion of the spermatic cord is an emergency, which must be treated surgically within 6 hours. Beyond that, arterial ischemia can become irreversible.


What germs can be responsible for Fournier's gangrene?


In a patient with lower urinary tract symptoms (UAB), what are the differential diagnoses of benign prostatic hyperplasia? (one or more exact propositions)

At the slightest doubt, it is necessary to perform a urethral fibroscopy

The presence of peripheral neurological pathology must suggest bladder hypoactivity, objectified to the urodynamic balance (BUD)

To be eliminated by a digital rectal examination, and a PSA in case of doubt (which must be normal in BPH)


What are the side effects of treatment with alfuzosin (alpha-blocker)?

AE of alpha-blockers: HO, anejucalation, IC before eye surgery

5-alpha-reductase inhibitor AEs: libido/erectile dysfunction. Divides PSA by 2

AEs of phospho-di-esterase 5 (IPDE5) inhibitors


Which of the following are exact in benign prostatic hyperplasia?

The clinical complaint is not proportional to the volume of the prostate

The digital rectal exam finds a flexible prostate

Digital rectal examination is usually painful

TR: flexible, painless, smooth, regular, disappearance of the median groove

A post-voiding residue is a disorder of the voiding phase

Impact on the lower urinary tract: voiding phase (dysuria, weak stream) and post-voidition (drops, post-voiding residue).

ECBU is routine to rule out bladder cancer


What are the risk factors for clinical progression of benign prostatic hyperplasia?

The IPSS score is to be done systematically but is not a risk factor for complications