Which of these stains can highlight lipids?

Sudan dyes are synthetic dyes characterized by a nitrogen group. Their main property is to be soluble in hydrocarbons, oils, fats and waxes, which are then colored.

It is the dye used to highlight Acid-Alcohol-Resistant Bacilli (tuberculosis bacilli)


Genital bleeding is a very rare reason for consultation in general practice

The main etiology is urinary tract infection

2 main etiologies: hormonal dysfunctions + pregnancy

Pregnancy is a leading cause of genital bleeding

The essential complementary examination is the LH/FSH assay

They are therefore not limited to uterine haemorrhages


A distinction is made between vulvar hemorrhages, vaginal hemorrhages and cervical hemorrhages

These are the three subtypes of hemorrhages

In case of suspicion of adenomyosis, MRI is indicated

Postmenopausal endometrial cancer should be suspected

Upper genital hemorrhage originates from the cervix

This would be a lower genital hemorrhage. High = hutterine cavity externalized by the cervix

The duration of normal menstruation is between 3 and 6 days

Normal abundance is between 50 and 80 mL


Regarding abnormal bleeding during menstruation:

Conventionally the periods are more abundant the first 3 days and less abundant thereafter

Normal period blood is coagulable, like venous blood

Rules with anomalies of duration and abundance

The prevalence of menometrorrhagia is around 1% in the general population


Functional metrorrhagia are due to endometrial alteration

Often caused by an imbalance in the estrogen-progestin balance

Organic bleeding affects the cervix most often

Uterine, tubal or ovarian pathology. Bleeding from the cervix is part of lower genital bleeding

The causes of menoage and metrorrhagia are often intertwined

Genital bleeding is not limited to uterine hemorrhages

They are due to a permanent or temporary alteration of the endometrium caused by a hormonal imbalance of the estrogen-progestin balance


Biotherapies have existed for a hundred years

Biotherapies are molecules taken from the human body and injected in large quantities into sick people

They are substances produced and purified from the use of living organisms for the purpose of treating diseases

Background treatments are opposed to symptomatic treatments

DMARDs are Drug Modifing the Activity of the Rheumatic Disease

Synthetic and biological DMARDs are separated


A distinction is made between original bDMARDs (boDMARDs) and biosimilar bDMARDs (bsDMARDs)

Biosimilars are copies of the original molecules but require the same technology to produce them.

The boDMARD are cheaper than the bsDMARDs


The tsDMARDs are the targeted synthetic DMARDs

The bsDMARDs are the biological original DMARDs

There are twelve biotherapies that have a MA in chronic inflammatory rheumatism and autoimmune diseases

The prescription of biomedicines is governed by an initial hospital prescription (PIH)

The first-line prescription in osteoarthritis is methotrexate


Regarding the indications for targeted therapies:

If contraindications to methotrexate in RA are prescribed.

In RA, it is generally advisable to combine biotherapy with DMARD

Secukinumab has MA for ankylosing spondylitis

Secukinumab has MA only in ankylosing spondylitis


What are the indications for phenotyped red blood cells?

Unless at risk of repetitive transfusions


Which of these substances can cause secondary Raynaud's syndrome?

Class III antiarrhythmic according to the Vaughan-Williams classification. It delays the repolarization of the heart cell and extends the refractory period of the latter homogeneously. It has no significant effect on vasoconstriction of finger arteries.

It is the beta-blockers that cause peripheral vasoconstriction

ACE inhibitors (which then reduce the production of angiotensin II) do not have significant effects on the arteries of the hands

calcium channel blockers, such as nifedipine or amlodipine, reduce the number of seizures and decrease their severity through their vasodilator effect


Which of these proposals concerning Raynaud's syndrome is true?

The syncopal phase begins the phenomenon

During the syncopal phase, the fingers are red

The syncopal phase is accompanied by cutaneous hyperesthesia

Rather, there is cutaneous hypoaesthesia


Raynaud's phenomenon is the most common acrosyndrome.

Acrosyndromes may be accompanied by trophic disorders

Scleroderma may accompany Raynaud's phenomenon

Raynaud's disease is the only etiology of Raynaud's phenomenon

Raynaud's phenomenon can have many etiologies: Rayaud's disease, scleroderma, Leo Burger, ...

Essential acrocyanosis finds hot and painful extremities

In essential acrocyanosis, the extremities are purple, cold, clammy and painless.


Which of these proposals are acrosyndromes?

Skin lesions after exposure to cold and/or moisture


It is also called Thromboangiitis Obliterans

It is characterized by segmental and inflammatory obliteration of medium and small vessels

The role of tobacco appears essential in the initiation and clinical aggravation of the disease.

It is benign and does not require further examination

An underlying immunological cause or thrombophilia (inflammatory or immunological assessment for ANCA, antiphospholipid antibodies, or antinuclear antibodies) must be ruled out and imaging tests are often required

Calcium channel blockers are proposed as a first-line treatment

There is currently no specific treatment for Buerger's disease. Only smoking cessation has been shown to be effective


The basics of autosomal dominant polycystic kidney disease (ADPKD):

Autosomal dominant polycystic kidney disease has a prevalence of 1/1,000 in the general population

It causes about 60-80% of end-stage renal failure

The leading cause of ESRD is hypertensive nephropathy. ADPKD is responsible for 8-10% of IRTs

Transmission of the disease occurs in an autosomal dominant manner

The gene concerned is located on the Y chromosome

It is either chromosome 16 (for PKD1) or chromosome 4 (for PKD2)


It's the opposite: the frequency of PKD1 is 85%

About 5% of patients have a de novo mutation

Abdominal ultrasound can evoke the diagnosis

The diagnosis is most often made from the age of 60, when renal failure becomes terminal

It is usually in young adults (hypertension, abdominal thinker, etc.)

After the age of 40, the presence of less than 2 cysts excludes the disease


Ultrasound has a higher sensitivity than CT scan

Cysts are multiple and bilateral most often

Cysts are responsible for compression and progressive fibrosis of the non-cystic renal parenchyma

ADPKD is therefore glomerular nephropathy


The exact characterization of the mutation in question is essential

Being a polygenic disease, with relatively independent management of the type of mutation, accurate genetic analysis is both complex and unnecessary

The mode of transmission concerns gonosomes

Chromosome 4 (PKAD 2) and 16 (PKAD 1) mostly

It requires a family tree for the identification and monitoring of relatives

It is linked to de novo mutations in 90% of cases


What are the symptoms possibly caused by autosomal dominant polycystic kidney disease?


Regarding the conscriptive cerebrity aneurysms of PKAD:

The prevalence of cerebral aneurysms is 40% in case of confirmed PKAD

8%, or 16% in case of family history of aneurysm. In the general population, the prevalence is 1.5%

They sit preferentially within the Willis polygon

Screening angio-MRI should be offered before age 50 to first-degree relatives of PKRAD patients who have ruptured a cerebral aneurysm


A brain aneurysm should be routinely tested for by MRI angiography in all patients with ADPKD

False. Only if a patient has a 1st degree family history of brain aneurysm, or if the patient is doing a risky job (e.g. airline pilot)

In a family with ADPKD, an unaffected person does not transmit the disease

About 5% of patients have a de novo mutation, i.e. one not transmitted by a parent

When faced with the diagnosis of ADPKD, it is not currently indicated to identify the genetic mutation in families, except in special cases

If a mother with ADPKD wishes to have a child, she can have genetic counselling and pre-implantation diagnosis.

False. This is not provided for in the ADRP


In what circumstances(ies) can the diagnosis of ADKDP be affirmed?

6 cysts per kidney in a subject over 60 years of age

1 cyst on the right kidney and 2 cysts on the left kidney in a 45-year-old subject

False. It takes ≥ 2 cysts / kidney between 40 and 60 years to make the diagnosis.

4 cysts per kidney in a 63-year-old subject

False. It is necessary ≥ 5 cysts / kidney from 60 years

1 cyst on the left kidney and 2 cysts on the right kidney in a 33-year-old subject

True. ≥ 3 uni- or bilateral cysts if the subject is under 40 years of age.

5 cysts on the right kidney and 4 cysts on the left kidney in a 69-year-old subject


A patient under 18 years of age with a parent with ADPKD should be screened by abdominal ultrasound

False. No screening of minors. Abdominal ultrasound will be done after 18 years

In a patient under 18 years of age with a parent with ADPKDP, paediatric follow-up with annual monitoring of hypertension is required.

Renal involvement is secondary to the progressive development of multiple cysts in both kidneys, responsible for compression and progressive fibrosis of the non-cystic renal parenchyma.

Cysts are developed only at the expense of the distal renal tubules

False. Cysts are developed at the expense of any renal tubule

The growth of cysts results from a proliferation of the cells lining the cysts, and a secretion of fluid by these same cells


In front of a patient affected by ADPKD and who has macroscopic hematuria without fever, it is necessary to evoke what diagnosis(s)?


Which of the following proposals may be present in a patient with ADPKD?


Regarding the management of intracystic infections. Which of the following are true?

If ECBU does not show bacteria, the diagnosis of a kidney cyst infection may be rejected

False. ECBU is often sterile because the bacteria are in the cyst.

Dual therapy with C3G + amikacin is recommended

False. Fluoroquinolone + Cotrimoxazole 3 to weeks

It is necessary to systematically puncture the cyst to evacuate its contents

False. A puncture of the cyst will be done when there is a persistence of fever > 7 days under dual antibiotic therapy

A PET scanner is systematically recommended

False. The PET scanner can be done in case of failure of antibiotic therapy


Generalized oedema is the consequence of extracellular hyperhydration

An anasarca corresponds to edema of the lower limbs that do not disappear after 3 months

It is the association of generalized edema and effusions of serous

Generalized edema is not accompanied by ochre dermatitis

A venous obstacle can only involve generalized edema

The formation of edema requires increased purification of salt by the kidneys

On the contrary, sodium and water retention is observed by the kidneys


The increase in capillary hydrostatic pressure corresponds to an increase in Starling force

Areas with minimal capillary hydrostatic pressure are deck zones.

The capillary hydrostatic pressure is, on the contrary, maximum in the detached zones. This is why edema is formed preferentially in these areas (lower limbs when the patient is in an upright position, lower back when he is in a horizontal position)

The amount of sodium contained in the human body determines the extracellular volume

The regulation of the body's sodium capital is carried out by the liver

True hypervolemia is sodium retention by the kidney


Regarding the etiologies of edema and their clinical signs:

In heart failure, antinatriuretic systems are stimulated and reabsorb sodium and water

The increase in blood volume following the positive sodium and fluid balance increases filling pressures and improves cardiac function

True hypovolemia is observed in hepatic cirrhosis

It is an effective hypovolemia that is due to the sequestration of blood in the splanchnic territory

Clinical signs begin to be frank from 100 mL of edema

They are frank when they exceed 3% of body weight (2L at least)

Generalized edema is white, soft, painful and does not take the bucket

They are bilateral, symmetrical, declivated, white, soft, painless, taking the bucket


Regular weighing of a patient is the best parameter to evaluate the effectiveness of the treatment put in place

Edema has no clear consequences on the biological balance

Hemodilution and decreased hematocrit and protein are observed

Natriueresis is preserved in the phase of constitution of edema

Chronic or acute viral hepatitis can cause edema


An increase in capillary hydrostatic pressure


A 50-year-old patient consults for edema of the lower limbs. The balance sheet finds a hypertension, an albuminemia at 20 g / L, a proteinemia at 50 g / L, a natremia at 120 mmol / L. BU: 3 cross of prot, a cross of red blood cells, no leukocyte. The patient presents:

Natremia reflection of the intraCR sector

Nephrotic SD: Proteinuria + Hypoabuminemia. Impure because hematuria and HTA.


The quality of care and the health system is a real public health issue

Health system evaluation structures were created very late. The first (ANDEM) was created in 1989.

The HAS (Haute Autorité de Santé) was created in 1946

2004. She is the descendant of ANAES (1996), herself who comes from ANDEM (1989)

The quality approach is inspired by the world of industry and services


Quality of care is an approach that must allow:

To guarantee him the best care (not necessarily cure)

Have a minimum cost for acceptable results

Have a minimum cost for the best result (concept of efficiency)

To bring the best satisfaction to the stakeholders (patients and caregivers)


Concerning the generalities of the quality approach

The France was very early in the field of quality approach with many institutions created in the 19th century

The France has been slow to set up evaluation structures: ANDEM in 1989 (National Agency for the Development of Medical Evaluation), which became ANAES in 1996 (National Agency for Accreditation and Evaluation in Health), then HAS in 2004 (High Authority for Health)

The formalization of a "quality approach", inspired by the world of industry and services, gradually developed in France, after having imposed itself in Anglo-Saxon countries.

Quality is the set of properties of a product that make it last over time

Set of properties and characteristics of a product or product that give it service the ability to satisfy expressed or implicit needs (ISO 8402)

Quality assurance is the set of actions necessary to give the appropriate confidence that a product or service will meet the requirements

The quality approach is the set of actions to satisfy customers and users.


Which of these proposals are indicators of quality and safety of care?

It is an indicator. It does not validate one.


Regarding quality and safety of care indicators:

3 types: structure indicator, process indicator, result indicator

Cross-cutting themes and specialty themes"


Each hospital has the obligation to have a quality department with a quality manager.

The continuous quality improvement approach is symbolized by the Demin wheel

A quality and safety of care indicator is a tool for tracking the costs of safety procedures

Tool for measuring a state of health, one or the practical occurrence of an event, which makes it possible to evaluate in a valid and reliable way the quality of care and its variations in time and space

The scope of application of quality indicators is limited to peripheral CHU and CHU with more than 200 employees

Public and private health institutions by the HAS: IPAQSS program (Indicators for the Improvement of Quality and Safety Management of Care)

The HAS regularly informs the ARS of the commitment and progress of the establishments in the certification procedure.


Regarding the certification process for healthcare facilities

The interface document must be sent 3 weeks before sending the quality account

Sent by the establishment to the HAS in the 6 months preceding the sending of the Quality Account (i.e. 12 months before the visit)

The HAS chooses a visit date for certification and has the legal obligation to respect it

The HAS may postpone the certification visit if important points of patient safety management are not fulfilled by the institution, after analysis of the interface document

The method of analysis of the quality account is chosen and specific to each institution: it is not imposed by the HAS.

The HAS has the sole role of visiting the establishment and issuing (or not) the certification based on it only

It carries out a quality control of the Quality Account: it can request additional information

The visiting experts are appointed by the HAS


Regarding the different levels of certification:

Certification with improvement recommendation is valid for 3 years

The decision to suspend certification requires a follow-up visit within 6 months

A new decision will be rendered at the end of this follow-up visit

Simple certification is valid for 4 years

Certification with improvement obligations requires the sending of a quality account 12 months before the visit


The HAS makes the decision to certify or not an establishment after analyzing the recommendations of the CREDO

The certification report is confidential and the health institution is prohibited from disseminating it

The institution must: ensure the widest possible dissemination of the certification report (CME, CDU ...) make available to the public the results of the quality and safety of care indicators

The institution's welcome booklet for inpatients must include information on the results of the various procedures for assessing the quality of care.

The HAS website must not contain hospital certification reports

The HAS publishes the certifications and the various reports on its website

The accreditation of doctors is implemented by the HAS


Which of these specialties are subject to accreditation?

Obstrical ultrasound, gynecology-obstetrics, surgeries, anesthesia-resuscitation, intensive care and interventional specialties


Crohn's disease can affect all segments of the digestive tract, most commonly the terminal ileum, colon and anus.

Crohn's disease can start at any age but its peak frequency is between 20 and 30 years

To make the diagnosis, it is necessary to perform an eso-gastro-duodenal endoscopy and an ileocolonoscopy with biopsies of the injured areas but also macroscopically healthy areas

The endoscopic lesions of Crohn's disease are very specific

The endoscopic lesions of Crohn's disease are not specific

Lesions extend into the digestive tract without leaving gaps of healthy mucosa

Intervals of healthy mucosa are possible,


Among the characteristics of ulcerative colitis:

It is absent: there is no involvement of the anus in UC

The colonic extension can reach, at most, the cecum

There are healthy mucosa intervals between lesions

Lesions do not leave a healthy mucosa gap


Regarding the etiologies of progressive visual acuity decreases:

Cataract is a clouding of the vitreous humor

The topography of cataract clouding is always peripheral

It can be nuclear (central), cortical (peripheral) or posterior

Chronic open-angle glaucoma is immediately symptomatic

Long asymptomatic, unlike angle-closure glaucoma

The most common hereditary maculopathy is Stargardt's disease

Retinopathy pigmentosa concerns batônnets in priority

Sometimes the damage can extend to the cones and lead to complete blindness.


Which of the following are part of the posterior segment?

It is on this fibrous support shell that the oculomotor muscles are inserted. It is also in its posterior part that the optic nerve is inserted.


Which of the following proposals are transparent environments of the eye?

3 transparent media: vitreous body, aqueous humor, crystalline


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


An ulcer is defined as a loss of substance from the gastric or duodenal wall deeply affecting the muscular.

Gastric or duodenal ulcers (UGD) result from the imbalance between chlorhydropeptic aggression and defense mechanisms (mucosal barrier) at a specific point in the mucosa

H. pylori is a gram-positive cocci that resists gastric acidity thanks to its urease activity and colonizes the surface of the gastric mucosa

H. pylori infection is most often acquired in childhood by the oral-oral or faecal-oral route

Most often, gastritis with HP does not get complicated


Selective NSAIDs (coxibs) that inhibit COX-2 by preserving COX-1 activity reduce the risk of ulcerative complications

They do not eliminate this risk but reduce it, in fact

Zolliger ellison syndrome should be evoked in case of multiple or recurrent ulcers, which are often complicated

"Stress" or psychological factors have no demonstrated role in the pathophysiology of ulcer

The incidence of DMUs has increased in developed countries over the past 3 decades

The incidence of GDU has declined in developed countries over the past 3 decades in line with the decline in gastric H-infection.

Duodenal ulcer is less common than gastric ulcer before age 55


The mortality rate for ulcerative complications is about 10%

The typical ulcer syndrome is an association of epigastric pain, without irradiation, punctuated by meals with a free interval of 1 to 3 hours, type of cramp or painful hunger, calmed by taking food or antacids.

This is the classic definition. Beware, however, of atypical syndromes

Physical examination is normal in the absence of complications

Upper GI endoscopy allows to visualize the upper digestive tract up to the second duodenum and to perform biopsies

Gastrodudenal endoscopy is the key diagnostic test


Gastric ulcer is at risk of cancerization

NSAIDs are responsible for one-third of ulcer complications

Duodenal ulcer requires systematic healing control

The eradication treatment of H. pylori is based on antibiotics only, for 10 to 14 days depending on the chosen protocol

Antibiotics + PPI +/bismuth salts according to protocol


Which of the following are true for Helicobacter pylori?

It is a risk factor for gastric carcinoma (in case of gastric atrophy)

Also called Endobrachyoesophagus
Risk factors tend to be overweight or chronic GERD


It is a risk factor for the occurrence of duodenal ulcer

It is contracted most often in childhood

100% of Helicobacter pyloria infections progress to gastritis

True, according to Figure 9.2 of the 4th edition of the HGE College


Regarding genital bleeding in the 1st trimester:

Genital bleeding complicates about 25% of pregnancies

A molar pregnancy is a very rare cause of 1st trimester hemorrhage

Cervical cancer is a very rare cause of 1st trimester hemorrhage

The vaginal examination makes it possible to check the permeability of the cervix and the possible presence of a laterouterine mass

The vaginal touch makes it possible to appreciate the condition of the cervix, the uterine volume, the appendages. TRUE

Genital bleeding of the first trimester is frequent, it does not require additional examination

Any genital bleeding in a pregnant woman should be explored. The main complementary examinations are: • plasma assay of 'hCG in case of doubt about the state of pregnancy, an endovaginal ultrasound and a urine strip. A blood test will be performed in case of significant hemorrhage with hemodynamic impact.


Which of these signs is (are) in favor of spontaneous abortion?

A disappearance of sympathetic signs of pregnancy

Dark blood hemorrhages without clots or debris

Light red blood, abundant, with clots and debris


The presence of an intrauterine device is in favor of a GEU

If pregnant in a woman with an IUD, it is more likely to be a GEU. However, the IUD is not recognized as an ELT FDR. TRUE

A very large uterus is a clinical sign in favor of a GEU

In case of GEU, the uterus is smaller than the expected volume in case of intrauterine pregnancy.

There is a loose and open collar in case of GEU

In case of GEU, the cervix will be rather toned and closed

The presence of a painless laterouterine mass is a clinical sign in favor of a GEU

The inconstant laterouterine mass (the GEU) will typically be painful, pain may be caused in the lateral or posterior cul-de-sac (signs of peritoneal irritation)

A well-centered intrauterine egg sac in the uterine cavity points to a normal pregnancy.

Be careful, the "pseudo-bag" is to be distinguished from the gestational sac. Unlike the gestational sac, the pseudo-sac is centered in the cavity and without trophoblastic crown (unlike the gestational sac which is lateralized and with a peripheral hypoechoic area): it is often a blood clot
in the uterine cavity, in the process of expulsion, which can be found on ultrasound in case of GEU. Pseudo-sac is common and can lead to a misdiagnosis.


Trophoblastic disease or molar pregnancy is exceptional in the West, more common in Southeast Asia. It results from an abnormality of fertilization and is characterized by abnormal trophoblastic proliferation without possible normal embryonic development.

A molar pregnancy results in a uterus that is smaller than gestational age would like.

On ultrasound: the uterus is larger than the management age would like. It is occupied by a heterogeneous, flaky mass, containing multiple small vesicles. The ovaries are large, polycystic

Ultrasound finds no ocular cavity or visible embryo in case of trophoblastic disease.

Indeed, there can be no embryonic development in case of trophoblastic disease. TRUE

The diagnosis of molar pregnancy is ultrasound

The diagnosis evoked on ultrasound requires aspiration under ultrasound control with systematic histopathological examination

Molar pregnancy is accompanied by very intense sympathetic signs of pregnancy, as well as very high hCG levels. Treatment consists of aspiration of endouterine contents under GA, and monitoring of the correct decrease in hCG levels over time. In the absence of decay, invasive mole or cholangiocarcinoma (chemotherapy treatment) may be feared.


Regarding spontaneous abortions in the first trimester:

The main cause of spontaneous abortions in the first trimester is teratogenic self-medication

Banal for the doctor, miscarriage is often experienced by the woman as a guilt-inducing trauma, a source of concern for the future.
It is important to devote a few minutes to information: • the usual cause (60% of cases) of ASP is a chromosomal abnormality of the embryo, due to chance. Miscarriage is a commonplace phenomenon that affects 10 to 15% of pregnancies and has no consequences on the future obstetrics.

Physical activity is a factor in miscarriages

Physical activity and the car have nothing to do with it.

Miscarriage is a commonplace phenomenon that affects 10 to 15% of pregnancies and has no impact on the future of obstetrics.

The expulsion of the stopped pregnancy is imperatively done by surgery.

Two methods are available: • medical treatment with prostaglandins if the egg is small and bleeding is small, surgical treatment in other cases.

Repeated spontaneous abortions occur when at least five consecutive spontaneous abortions occur before 14 weeks.

At least three consecutive spontaneous abortions before 14 SA


Among these proposals, which is (are) a possible etiology(s) of repeated spontaneous early abortion:

Unbalanced diabetes (controversial). Otherwise: the possible causes of repeated ASP are:
a uterine malformation (rather responsible for late-term abortions); a hysterography must be done
lupus, an antiphospholipid syndrome
genetic causes (karyotype)
chronic endometritis (which may be caused by a chronic infection to look for)
hormonal and metabolic causes (dysovulation, hyperandrogenism, hypothyroidism, diabetes) that are classic but very controversial
immunological causes (immunization against spousal antigens).
The etiological balance is often negative."


Regarding repeated spontaneous abortions:

An etiological investigation becomes legitimate in case of repeated spontaneous abortions

The etiological balance is often negative

Preventive treatment of recurrence with low-dose aspirin and low molecular weight heparin has been proposed

This treatment is effective in case of antiphospholipid syndrome (placental vascularization disorders).
Otherwise, it has no interest. Some offer a low-dose preventive aspirin treatment based on the placebo effect. TRUE

Preventive treatment with aspirin and LMWH is effective in diabetes

Preventive treatment of recurrent ASP with misoprostol is proposed.

Misoprostol is a teratogenic PGE1 prostaglandin analogue used in medical terminations (GymsO, MisoOne)


A third trimester genital hemorrhage is an obstetric emergency

The diagnostic approach is focused on the differential diagnosis between the two main causes of placenta previa (inserted in part or in whole on the lower segment) and retroplacental hematoma, 2 therapeutic emergencies.

Vaginal examination is contraindicated until placenta previa has been ruled out

Risk of severe maternal hemorrhage, risk of extremely serious fetal hemorrhage in case of rupture of a praevia vessel.

The clinical examination focuses on fetal impact only

The examination focuses on: • maternal impact: pulse

A vascular context is in favor of a retroplacental hematoma

A small hemorrhage eliminates a retroplacental hematoma

Typically, retroplacental hematoma presents with:
a sparse, blackish, incoagulable hemorrhage associated with sudden, permanent uterine pain, which dominates the picture;
a severe maternal impact unrelated to the abundance of hemorrhages: prostrate woman, state of shock, tachycardia but variable BP, sometimes high (gestational hypertension, proteinuria)
a permanent and painful uterine contracture ("wooden belly")
unperceived fetal cardiac activity (dead fetus) in full forms.


There is little maternal impact, due to the low abundance of hemorrhages.

The maternal impact can be severe, unrelated to the abundance of hemorrhage.

A permanent and painful uterine contracture ("wooden belly") should evoke it.

A retroplacental hematoma without signs of severity can be managed on an outpatient basis

Treatment of an HRP is an emergency. The action to be taken involves hospitalization of the patient, urgent medical treatment (O2, filling, defibrination if necessary), the realization of a preoperative assessment and fetal extraction in emergency.

Emergency obstetric ultrasound is required

Retroplacental hematoma is often visible on ultrasound

Rarely visible. A negative ultrasound does not eliminate the diagnosis


Hemorrhage of delivery is an obstetric emergency

The hemorrhage of deliverance is life-threatening fetal but not maternal

In its severe or neglected forms, it is life-threatening to the maternal

It is currently the third leading cause of maternal mortality in France

It is currently the leading cause of maternal mortality in France

Its early diagnosis is based on rigorous monitoring of any woman who has given birth, especially during the 2 hours after delivery.


Prevention is based on the injection of oxytocin at the time of placental expulsion.

The oxytocin injection is done at the time of release of the shoulder of the newborn (or in the seconds after birth), this is called directed delivery.

The recognition of a hemorrhage of delivery requires a precise quantification of bleeding.

The hemorrhage of delivery is defined by bleeding > 500 ml. Management must be immediate.

There are no risk factors found in more than 50% of cases of hemorrhage of delivery.

There are deliveries with a "low risk" of hemorrhage of delivery.

In more than half of the cases of hemorrhage of delivery, no risk factor is found: any woman who gives birth has a possible risk of hemorrhage of delivery. It is one of the
Reasons why we can never speak of "low-risk" birth.

The presence of a scarred uterus is a protective factor against hemorrhage of delivery due to the slightest distension of the fibrotic uterus.

The risk factors are:
• fibroids
• Placenta previa
• scar uterus
• history of hemorrhage of delivery
• the work triggered
• very fast or prolonged work
• hyperthermia
• macrosomia, hydramnios, multiple pregnancy;
• Greater multiparity
• no uterotonic injection (oxytocin 5 to 10 IU IVD) in the seconds that
follow the birth of the child


Regarding the management of a hemorrhage of delivery:

The first step is to carry out an artificial delivery in emergency.

True, if the hemorrhage occurs before the placenta is expelled.

Inspection of the genital tract under valve is systematic only in case of strong argument for a vaginal tear.

It is systematic in case of haemorrhage of delivery.

The administration of uterotonics is done only in case of absence of previous injection of oxytocin.

The injection of oxytocin after artificial delivery should be systematic and is part of the treatment of hemorrhage of delivery, even if the injection has already been performed at birth.

The management of the hemorrhage of delivery involves endouterine gestures (artificial delivery + uterine revision). Antibiotic prophylaxis should therefore be administered.

In a second step, sulprostone can be injected.

In case of persistence of hemorrhage, the second usable uterotonic is suprostone (analogue of prostaglandin E2 with oxytocic activity). In the absence of improvement, interventional radiology (embolization of bleeding arteries) or surgery (ligation of uterine arteries, up to hysterectomy if necessary) will be used.


Prostaglandin therapy should be administered within 30 minutes of the start of management if bleeding persists.

Administration of sulprostone should occur within 30 minutes of diagnosis of delivery haemorrhage. In case of oxytocin failure, this period may be shortened depending on the severity of the bleeding (reco CNGOF 2014).

The uterine revision is carried out immediately in front of any hemorrhage of delivery.

It is performed after artificial delivery if the expulsion of the placenta has not taken place, otherwise immediately after natural delivery.

In some situations, it is possible to perform hemostasis by uterine tamponade with an intrauterine balloon.

If radiological and surgical techniques are not readily available, this may be a waiting solution until a possible transfer to a specialized unit.

In case of unstable hemodynamics, the preferable management is surgical.

Management must be extremely rapid in case of unstable hemodynamics, which does not leave time to perform a transfer or radioembolization.

Monitoring of the coagulation balance is not imperative.

The sometimes rapid evolution of coagulopathy during a hemorrhage of delivery justifies biological monitoring of coagulation (reco CNGOF 2014)


Cardiac output decreases due to hypervolemia

It increases precisely to cope with vasodilation

Solidarity does not appear until the third trimester


One must objectify a HTA, ie a PAs greater than or equal to 140 mmHg and / or a PAd greater than or equal to 90 mmHg

Proteinuria is greater than 30 mg/24h in pre-eclampsia

One of the consequences of pre-eclampsia can be intrauterine growth retardation


What are the blood pressure goals in a hypertensive pregnant woman?

These are the same as in non-pregnant women

BP figures < 140/90 mmHg are not targeted because this would result in fetal distress

The blood pressure objectives are a PAs < 160 mmHg and a PAd between 85-100 mmHg


What are the reasons for a HELLP syndrome?

H = hemolysis. EL = Elevation of liver enzymes. LP = Low Platelets


Which of the following are molecules that can be used for tocolysis?

They can cause maternal undesirables sometimes serious.
It is recommended that they no longer be prescribed.


Which of the following are among the benefits of antenatal corticosteroid administration in case of threat of premature delivery?

Reduction in the rate of maternal-fetal infection

Reduction in the rate of hyaline membrane disease

Reduced rate of ulcerative-necrotizing enterocolitis


Which of the following should be made upon admission of a patient at risk of preterm birth?

Collection of a biological assessment including among others an NFS and CRP

True, in search of a biological inflammatory syndrome, in favor of an intrauterine infection


The period of the postpartum period is between 2 hours postpartum and about 40 days

The most common cause of postpartum fever is milky rise and therefore does not require exploration

This is the milky rise, but it is a diagnosis of elimination so it is necessary to eliminate infectious etiologies, thromboembolics, etc.

If breastfeeding is artificial, the main causes of postpartum fever are related to accumulated stress

No. In this case, the main causes of fever are endometritis, urinary tract infection and thromboembolic disease.

Endometritis is a cause of postpartum fever

The diagnosis of endometritis is clinical


Which of these proposals designate a factor promoting endometritis?


The onset of endometritis is often late, around 30 days postpartm

No, it is often early: 3 to 5 days after delivery

Stagnant uterine height and gaping cervix are signs of endometritis

Management of endometritis is most often ambulatory

In case of endometritis, antibiotic therapy is started when the susceptibility test is ready

It is started directly in IV and then adapted secondarily to the results of vaginal ECB

The optimal duration of antibiotic therapy is between 5 and 10 days


Endometritis is rapidly favorable under appropriate treatment

The clinical picture of a urinary tract infection has nothing to do with postpartum, compared to the clinical picture of a UTI outside a pregnancy context

The clinical picture and principles of treatment are identical

ECBU confirms diagnosis of urinary tract infection

Renal ultrasound is of no use in acute postpartum pyelonephritis

Antibiotic treatment should be compatible with possible breastfeeding (3rd generation cephalosporins ± aminoglycoside) and continued for a total of 21 days. 5-10 days is the duration of treatment for endometritis


Palliative care occurs only in the last stage of the disease

It is care that accompanies the patient throughout his care, intended to relieve annoying symptoms such as pain

Palliative care only concerns people over the age of 65

Palliative care is incompatible with curative care

They are quite compatible with the goal of curing the disease

Palliative care is reserved for patients with a VAS of pain greater than 6/10


Which of the following are some medications that can cause constipation?

The main drugs responsible for constipation are: morphine, most psychotropic drugs, thiazide diuretics, GABA analogues, platinum salts and iron.


Which of the following are palliative care goals?

Of course not. It is about relieving pain and supporting patients by improving their quality of life.

The palliative care approach may be similar to some psychological techniques, but the latter are much more comprehensive and complex to be palliative care goals.

Relieve the patient of symptoms altering his quality of life


The sensation of grains of sand in the eye evokes conjunctivitis

Blepharospasm suggests angle-closure glaucoma

The pains are devastating and very intense in episcleritis

Episcleritis is accompanied by moderate pain

Severe pain with irradiation in the territory of the trigeminal nerve evokes acute glaucoma

Conjunctivitis is not accompanied by a decrease in visual acuity


A red eye without visual field abnormalities may suggest subconjunctival hemorrhage or episcleritis

Subconjunctival hemorrhage is not painful. Episcleritis is moderately painful.

The clinical examination is bilateral and comparative

Visual acuity is measured from far and near, with possible optical correction

A conjunctival wound should be systematically searched, even without apparent trauma

MRI is indicated in emergency in case of intraocular foreign body

Contraindicated because risk of projection of the foreign body. An orbital CT scan is done.


Concerning the clinical examination with the slit lamp and fluorescein:

Eye redness is diffuse in case of conjunctivitis

Ocular redness is sectorized in case of episcleritis

Healthy corneal epithelium does not bind fluorescein

Localized ulceration with an adjacent white area suggests bacterial keratitis with a corneal abscess

Cf. Item in the latest edition of the College of Ophthalmology

A dendritic ulcer evokes posterior uveitis

A dendritic ulcer evokes herpetic keratitis


Regarding the iris, pupil and conjunctival cul-de-sac:

The presence of iridocrystalline synechiae is seen in anterior uveitis

A miosis is found in acute keratitis or acute uveitis

Areflexive semimydriasis is found in neovascular glaucoma


A narrow or flat anterior chamber suggests acute glaucoma or a puncture wound

The Tyndall effect is pathognomonic of retinitis

Retrocorneal precipitates found in anterior uveitis

The measurement of ocular tone is carried out with an air tonometer or flattening

Hypotonia is suggestive of a transfixing eye wound

Seidel's sign highlights an aqueous humor leak that washes the previously instilled fluorescein.


Viral conjunctivitis is accompanied by the presence of lymphoid follicles

Spontaneous subconjunctival hemorrhage is a major surgical emergency

Frequent, banal, painless, it regresses in a few weeks without treatment

Subconjunctival hemorrhage should be tested for high blood pressure (hypertension) and/or a bleeding disorder

Conjunctivitis is manifested by a feeling of grains of sand in the eye

Conjunctivitis is very algic during the first 3 days


Anterior uveitis is the most common ophthalmological presentation in sarcoidosis

Intermediate uveitis (= hyalitis) and posterior uveitis may also be present, but are rarer than anterior uveitis

The existence of thick retrocorneal precipts and nodules defines the granulomatous character of acute anterior uveitis in sarcoidosis

Chronic anterior uveitis (> 3 months) occurs preferentially in young subjects

In middle-aged women (50-60 years). In young subjects, acute uveitis is more common.

Uveitis is typically acute and unilateral in sarcoidosis

It is most often chronic (> 3 months) and bilateral

Cysteoid macular edema is the main cause of decreased visual acuity in posterior uveitis


What are the 2 most common causes of intermediate uveitis (hyalitis)?

Sarcoidosis and MS are the 2 main etiologies of hyalitis. But hyalite is mostly idiopathic. Cf. Sarcoidosis in the College of Internal Medicine.


Anterior uveitis is defined as iritis or iridocyclitis

Inflammation of the uvea of the anterior segment

Intermediate uveitis is pars planitis and/or posterior cyclitis and/or hyalitis

Posterior uveitis is focal or diffuse choroiditis or retinochoroiditis or retinitis

Panuveitis is an attack of the 3 segments of the eye

Posterior uveitis is a cause of red and painful eye

It is only the involvement of the anterior segment (anterior uveitis) that can cause a red and painful eye


Urticaria is a common inflammatory dermatosis due to mast cell activation

Diagnosis of urticaria is based on increased isolated IgE

Urticaria corresponds to dermal edema with increased capillary permeability secondary to release by seortonin mast cells

Mast cells essentially release histamine. Hence the effectiveness of anti-histamines

Elementary lesions of superficial urticaria are edematous pustules

Whatever the type of lesions, they are itchy, fleeting, and migratory.


In deep urticaria, the edema is pinkish-white, firm and itchy in consistency

It is not itchy but gives a feeling of tension or pain

Superficial urticaria is isolated in half of cases, associated with angioedema in 40% of cases

In 70% of cases, there is only angioedema

There is only angioedema in 10% of cases, which require a different diagnostic and therapeutic approach

Insect bites and bullous dermatoses in the pre-bullous stage represent differential diagnoses of urticare

When urticaria is atypical, little or not pruritic, fixed, other diagnoses should be evoked such as urticarial vasculitis


Regarding eczema and the different forms of urticaria:

Acute eczema of the face may be responsible for edema lesions are fixed, vesicular and oozing

The diagnosis of physical urticaria is made at the interrogation

The diagnosis of cold urticaria is confirmed by the ice cube test

Confirmation of the diagnosis of solar urticaria is done by photo-test

The confirmation of urticarian dermographism is done by rubbing the skin with a foam tip


Which of the following is (are) correct?

The thyroid is under the control of pituitary hormone TSH which stimulates all stages of thyroid hormone biosynthesis.

In children, it is usually a Graves' disease

In important forms, X-ray radiography of the Turkic saddle can measure the degree of protrusion

Biosynthesis of thyroid hormones requires mercury


Hyperthyroidism is the set of disorders related to the hyperfunctioning of the thyroid gland

Thyrotoxicosis syndrome corresponds to the consequences of excess thyroid hormones when it is due to primary hyperthyroidism

Whatever its cause (for example, an excess of exogenous thyroid hormones)

The prevalence of hyperthyroidism is about 10% in the general population

The prevalence of hyperthyroidism is high but varies between countries (0.2 to 1.9% for all causes)

Thyroperoxidase, or TPO, allows the organification of iodide among other things


Regarding the causes and symptoms of hyperthyroidism:

Each of the TSHR, TPO, Tg proteins is likely to behave as an autoantigen

The thyroid mainly produces thyroxine (T4)

The half-life of T4 is approximately 5 days

Thyroid hormones have multiple effects by binding T3 to its membrane receptor

The T3 receptor, the active hormone, is nuclear. It enables rapid genomic response

The cardiovascular effects of hyperthyroidism are, in particular, regular tachycardia, sinus, exaggerated during efforts and emotions, persistent at rest


Regarding the diagnosis of hyperthyroidism:

Hyperthyroidism may be accompanied by hypotonic delirium that may be similar to depression

Neuropsychic disorders These disorders are characterized by: excessive nervousness, psychomotor agitation and mood lability; a n and regular tremor of the extremities (manoeuvre "of the oath"); on the contrary, we witness

Thermophobia is accompanied by excessive sweating, with warm hands

Weight loss due to hyperthyroidism is very often followed by weight gain due to excessive polyphagia

It is rarely followed by paradoxical weight gain. This is indeed the case when polyphagia "exceeds" hypercatabolism

Increased frequency of bowel movements: by accelerating transit; sometimes with real motor diarrhea

The first-line biological examination is the determination of free T4

This is TSH. TSH has collapsed, except in certain exceptional cases (examination to be requested in the first line according to HAS)


Regarding thyrotoxicosis and hyperthyroidism:

The elevation of free T4 and/or free T3 (there are hyperthyroidism with elevated T3 alone) makes it possible to assess the importance of thyrotoxicosis

The main heart rhythm disorder in thyrotoxicosis is supraventricular to atrial fibrillation type

Heart failure is classically predominantly left

Heart failure is: usually associated with AF; classically predominantly straight; with high or normal cardiac output

Osteoporosis is due to the osteoclastic action of thyroid hormones and predominates in the spine with a risk of vertebral settlement

This phenomenon is mainly observed in postmenopausal women

In Europe, the most frequent causes are, in addition to iatrogeny, in descending order: Graves' disease; toxic multinodular goiter; toxic adenoma


An abnormality of hemostasis may be evoked in the course of an suggestive clinical event (unexplained hemorrhage, unusual thrombosis) or because of an abnormal laboratory test systematically prescribed

The interrogation must specify, in particular, the spontaneous or provoked nature of the

Questioning and clinical examination help to distinguish a pathology of primary hemostasis from a coagulation disease, and point to a constitutional or acquired etiology

Petechial and / or echymotic purpura, spontaneous bleeding and / or caused point to an attack of hemostasis

Reference values in adults are usually between 30 and 40 seconds for the TCA


A significant prolongation of the TCA is defined by a ratio of sick time / control time greater than 1.2

Elongated TCA can detect antihemophilic factor deficiency when isolated

FVIII (antihemophilic factor A), FIX (antihemophilic factor B)

The prolongation of an TCA may indicate an asymptomatic deficiency, not predisposing to bleeding

The quick time explores the direct (so-called "extrinsic") pathway of coagulation

Bleeding time explores primary hemostasis as a whole


The expression in INR of the quick time is to be reserved for monitoring AVK treatments

Bleeding time (TS) is operator-dependent, with poor reproducibility and sensitivity

The result of bleeding time is predictive of bleeding risk

the result obtained is not predictive of the risk of bleeding

Willebrand disease is the most common constitutional pathology of hemostasis

Thrombopathy is suggested in the event of unexplained mucocutaneous bleeding, associated with a normal platelet count, normal TCA and TQ


Willebrand disease is caused by a quantitative or qualitative deficiency of Wilebrand factor

Willebrand disease is transmitted in the majority of cases in an autosomal dominant manner

The plasma level of wWF is between 50 and 150% in normal subjects

The clinical expression of Willebrand disease is very heterogeneous

Intramuscular injections are contraindicated in patients with willebrand disease


Congenital hemophilia is due to a deficiency of FVIII (hemophilia A) or FIX (hemophilia B, 5 times less common)

Hemophilia is inherited in an autosomal < recessive manner

Hemophilia is transmitted in a sex-linked recessive manner, with the FVIII and IX genes located on the X chromosome

Only boys are affected and women are drivers

The severity of hemorrhagic syndrome depends on the severity of the FVIII or FIX deficiency: the deficiency may be severe (< 10%)

The severity of hemorrhagic syndrome depends on the severity of the FVIII or FIX deficiency: the deficiency can be severe (rate < 1%), moderate (rate between 1 and 5%) or minor (rate between 5 and 30%)

Clinical manifestations are dominated by bleeding caused by sometimes minimal shock


Protein S acts as a cofactor of activated protein C (PCa)

The determination of protein S is part of the thrombophilia balance sheet


Regarding the generalities of psychotherapies:

It is 'Any method of treating psychic or bodily disorders using psychological means and, more precisely, the relationship between therapist and patient'

Any verbal exchange/conversation does not constitute psychotherapy although a simple verbal exchange can form a therapy provided it is structured around predefined criteria.

Psychotherapy aims to cure illness when drug treatments are ineffective

Psychotherapy aims to improve the overall well-being of the patient. This sometimes allows healing but not only in desperation when drug treatment is ineffective.

Psychotherapy is suitable for all patients because they can be almost totally passive

It implies on the part of the patient a request for care and change

All psychotherapy has a framework with its rules such as the number of sessions, their duration, etc.


Regarding the practice of psychotherapy:

A psychotherapist is an over-specialized psychologist

A psychotherapist can have different types of training: psychiatrist, psychologist, or specific training in psychotherapeutic technique without another degree.

The title of psychologist is at bachelor's level

The title of hypnotherapist escapes any regulation

The title of psychopractitioner requires a bac + 4 minimum

Not all psychotherapy is applicable to every patient


A common point to all these psychotherapies is the establishment of a quality therapeutic relationship, based on empathy.

Psychotherapy is not just a conversation

It is generally easier to measure the effectiveness of therapies focused on a defined symptom (such as a phobia) than on a global syndrome.

Supportive psychotherapy is considered first-level psychotherapy

Supportive psychotherapy is the least used technique

It is the most used and least theorized psychotherapy but it responds to a precise framework and defined techniques


The diagnosis of schizophrenia is biological

Delusions are characterized by their intensity and impact on normal ideation

Delusions are characterized by their theme, mechanism, systematization, adherence, and emotional and behavioral impact.

The impact of schizophrenia on life expectancy has recently become zero thanks to new management methods

Life expectancy is decreased, mainly due to comorbidities (including cardiovascular disease) and suicides

Management is based on pharmacological treatment with benzodiazepines

Management is based on antipsychotic pharmacological treatment, treatment of comorbidities and psycho-social rehabilitation (psycho-education, cognitive-behavioral therapy, cognitive remediation and psychosocial rehabilitation)


Schizophrenia was described in the early twentieth century as a common and severe disease

This disease is currently classified by the WHO among the ten diseases that cause the most disability, especially in young people.

It is characterized in the foreground by an alteration of language and memory

It is one of the chronic psychotic disorders that are characterized by an alteration of contact with reality

The etiology mainly found is iatrogenic (adverse effects of drugs, vaccines and GMOs)

The hypothesis of a neurodevelopmental disorder, which prevails today, postulates that schizophrenia is the delayed consequence of neurodevelopmental abnormalities beginning years before the onset of the disease.

The prevalence of schizophrenia is about 10% in the general population


The disease typically begins in late adolescence or in young adults between 15 and 25 years of age.

The age of onset is usually later in women compared to men by about 5 years

The emergence of schizophrenic symptoms is brutal and unexpected (thunderclap in a calm sky)

The emergence of schizophrenic symptoms is usually preceded by cognitive alterations and non-specific prodromal symptoms may be present 2 to 5 years before the emergence of the disorder

The sex ratio shows that women are more affected than men

The sex ratio is fairly balanced, although there is a slight predominance among men (x 1.4)

Delusions correspond to alterations in the content of thought resulting in an alteration of contact with reality


In schizophrenia, the prevalence of delusions is estimated at more than 90%

The theme of the delusional idea corresponds to the degree of reality of it

The themes are often those of self-flagellation

The themes can vary infinitely, be unique or multiple, associate with each other in a more or less logical way

The mechanism of the delusional idea corresponds to the process by which the delusional idea is established and constructed.

There are 2 different types of mechanism at the origin of delusions: hallucination and imagination

There are 4 types of mechanism at the origin of delusions: interpretative, hallucinatory, intuitive and imaginative mechanisms


The delusional idea theme evaluates the organization and coherence of delusions.

It is the degree of systematization that evaluates this

A delusional idea is considered unsystematized when the organization is fuzzy, vague and incoherent.

In schizophrenia, delusions are often very precise and systematized.

In schizophrenia, we find in the majority of cases delusions that are not systematized, fuzzy, without logic, incoherent, unlike the persistent delusional disorder of persecution type during which delusions are generally systematized and where coherence gives a certain logic to delusional production

Adherence to delusions is the degree of conviction the patient feels about these ideas.

When the conviction is unshakeable, inaccessible to reasoning and criticism, adherence is said to be "not reasonable"


When adherence is partial, the patient is able to criticize their own delusions.

Delusions very rarely induce self-aggression

Dangerousness for oneself or for others can be the direct consequence of delusions (escaping the conspiracy, atone's faults, taking revenge on a persecutor)

Persecution is a type of delusional idea in which the central theme for the subject is to be attacked, harassed, etc.

A somatic delusional idea has as its central theme the functioning of the body

A patient who explains that: "At 8pm, Laurent Delahousse spoke to me through television to tell me that I had to save the world" may be an example of a crazy idea of reference


Hallucination is defined as a perception without object

Schizophrenia is incompatible with real hallucinations

In schizophrenia, 75% of patients present with hallucinations, especially in the acute phase

Psychosensory hallucinations are sensory manifestations

In schizophrenia, all senses can be affected

Tactile hallucinations are extremely common and are found in more than half of patients with schizophrenia

Tactile hallucinations (superficial sense of touch) are present in about 5% of patients with schizophrenia


Hallucinations affecting taste are very common in schizophrenia

Olfactory hallucinations most often involve bad odors coming from the patient himself

Cenesthetic hallucinations concern internal sensitivity

Influence syndrome is characterized by the feeling of being directed and losing free will

Negative syndrome corresponds to depression associated with pre-existing schizophrenia

The negative syndrome includes clinical signs that reflect an impoverishment of psychic life


An anhedonia is the loss of ability to experience pleasure

Clinophilia can ultimately lead to negligence

The syndrome of disorganization corresponds to the loss of the psychic unity between ideas, affectivity and attitudes

In this disease, the ability to speak is preserved

Disorganization at the cognitive level is also manifested by a symptomatology affecting language

Catalepsy is a waxy flexibility of the limbs with maintenance of imposed attitudes


Precariousness is defined as a state of fragility and social instability

The 2 essential health security identified by the WHO is access to medicines and drinking water.

The essential health security identified by the WHO is much more numerous than this: * housing, * access to education and information, * adequate food in quantity and quality, * have a sufficient, certain and stable income, * benefit from a stable, protective ecosystem, * rely on a sustainable supply of resources, * have the right to social justice and fair treatment.

Precariousness corresponds to the modest social classes

Precariousness does not characterize a particular social category but a set of situations of insecurity and economic, social and family fragility.

Precariousness is a dynamic, reversible and multifactorial situation

A subject in a precarious situation does not have the means to support himself

Be careful, a subject in a precarious situation is not necessarily poor or excluded


Poverty is a term that generally refers to the financial dimension

Around 10% of the population lives below the poverty line

Exclusion is a static state that is difficult to adjust

Exclusion 113 Exclusion is a dynamic reality characterised by the absence for an individual, for a more or less long period, of the possibility of enjoying the same social rights as another individual

Exclusion requires medical care most often

Exclusion is not a disease, but it reduces perceived social support and creates a sense of social worthlessness and self-worthlessness that causes intense psychological suffering and difficulty in integrating into a social fabric.


Exclusion is the extreme form of precariousness

The phenomenon of precariousness, in the sense of the absence of one or more securities, affects about 5% of the population

Epidemiology: The phenomenon of precariousness, in the sense of the absence of one or more security measures, affects 12 to 15 million people in France, or 20 to 25% of the entire population.

In France, the gap in life expectancy at age 35 between blue-collar workers and senior managers is very small because of the welfare state.

It is important, from 8 years to 35 years and from 4.5 years to 60 years

Medical morbidity and mortality is not impacted by precariousness because access to emergency care is free

Medical morbidity and mortality is increased among individuals in precarious situations

Precariousness is a positive risk factor for the occurrence of psychiatric disorders


It must be differentiated from the odynophagia pain felt during the progression of food in the esophagus but without feeling of blockage of the diet

Dysphagia is a sensation of discomfort or obstacle to the progression of the bolus of food occurring during swallowing

Gastro-duodenal endoscopy is the key examination to do in the first place in front of any dysphagia

Even in the case of normal mucosa, mucosal biopsies should be routinely performed to look for eosinophilic esophagitis.

Endoscopic ultrasound is the most precise examination of the esophageal wall


If the gastro-duodenal endoscopy is normal, look for an esophageal motor disorder

Esophageal manometry: • is the key test for diagnosing motor disorders of the esophagus

Manotry may be useful to attach anginal-like chest pain to the esophagus

In case of lesional dysphagia, dysphagia in general predominates over fluids

dysphagia in general: • predominates over solids; • • and has an impact on the general condition

Eosinophilic esophagitis, which mainly affects humans, is associated in 50% of cases with atopic manifestations


In case of eosinophilic esophagitis the endoscopy may be normal, or visualize the following lesions: whitish granita, thickened mucosa with presence of vertical linear fissures, single or multiple strictures and appearance in "pseudo-trachea"

In Zenker's diverticulum dysphagia is high and associated with food regurgitation sometimes triggered by cervical pressure

Zenker's diverticulum diagnsotic occurs on gastro-duodenal endoscopy

Zenker's diverticulum is CONTRAINDICATED to EOGD because of the risk of perforation

Achalasia is a primary motor disorder of the esophagus of unknown cause, defined by the complete absence of peristalsis in the body of the esophagus.

The most common organic causes of dysphagia are tumors and esophagitis


The diagnosis of achalasia is endoscopic

Esophagitis with esopniphilia can cause food impaction

Esophageal cancer causes progressive dysphagia that starts with fluids

Oro-pharyngeal dysphagia is essentially ENT or neurological

Secondary motor disorders of the esophagus may be observed in scleroderma or diabetes


Gastro-duodenal endoscopy (EOGD) is the key test to do first in front of any dysphagia

CT is the most effective method for diagnosing esophageal and esophagitis tumours

EOGD is the most effective method for diagnosing esophageal and esophagitis tumors

EOGD allows both the precise study of the mucosa and the realization of biopsies

Great maneuverability and live << visualization>>

Even in case of normal mucosa, mucosal biopsies should be routinely performed to look for lymphocyte esophagitis

Eosinophilic esophagitis is sought, which is often associated with blood eosinophilia and atopic manifestations

The chest CT scan makes it possible to look for a mediastinal lesion and appreciates the parietal, mediastinal and lymph node extension of cancers


Eckart's score ranges from 0 to 3 and is for dysphagia.


Dysphagia is a feeling of discomfort or obstruction to the progression of the bolus of food occurring during swallowing

Odynophagia is pain felt during the progression of food in the esophagus but without a feeling of blockage of food

The "globus hystericus" is a sensation of cervical striction related to the endobrachy-esophagus

Odynophagia electively affects certain foods

Oropharyngeal dysphagia results in difficulty initiating swallowing and propelling the bolus into the esophagus.

True. The causes of oropharyngeal dysphagia are mostly ENT or neurological


Which of the following proposals may be responsible for esophagitis?


Which of the following are true for esophageal candidiasis?

The immunocompromised terrain is at risk

It may be responsible for dysphagia without stenosis

It may be responsible for squamous cell carcinoma

False membrane deposits are found at FOGD


Which of the following proposals are in favor of adenocarcinoma of the esophagus?

In favor of squamous cell carcinoma of the esophagus

History of gastroesophageal reflux disease

Chronic GERD and overweight are the 2 main risk factors for EDA of the esophagus


Which of the following are possible causes of dysphagia?

True, is accompanied by fasciculations of the language

True, delayed complication of radiation therapy

Zencker's diverticulum (Meckel = digestive)


Squamous cell carcinomium of the pharynx


Which of the following are true about eosinophilic esophagitis?

Treatment is based on the prescription of antihistamines

False, survival relatively little impacted

Biopsies show infiltration by PNE 35% per field


The etiologies of chronic cough are more or less the same as those of acute cough

The majority of acute coughs are allergic

Especially post-infectious and they do not require investigation

Chronic cough is often a defensive phenomenon in response to aggression

Coughing involves a reflex neural arc whose conduction pathways are still unknown to this day.

Cough is a relatively rare symptom in liberal


We speak of chronic cough when the duration is greater than 3 weeks in French literature

Post-infectious coughs require a biological work-up

A chronic cough can cause a rib fracture

Urine loss associated with chronic cough should suggest overactive bladder

Capsaicin stimulates C-fiber receptors and causes coughing


Which of the following suggest causes of iatrogenic cough?

There are also vaporized or inhaled drugs


Which of the following suggest causes of organic cough?

It is an iatrogenic cause, not an organic one


Chronic interstitial nephropathies include a wide variety of pathologies

Most often, the course is rapid and fatal without treatment

Repeated history of UTIs supports a diagnosis of NIC

Sjögren's syndrome is one of the etiologies of NIC


Which of these proposals are signs of NIC?

There is no indication of impact or link (in the repository in any case) between the T2D and the NICs

It is chronic and slow-growing. GFR drops by less than 5 ml/min each year


Ultrasound shows significant dilation of the kidneys and possible cysts

Kidney biopsy is urgent for diagnostic purposes

Most often, it is not performed, because of the small size of the kidneys and the often very suggestive clinical context

Histology is non-specific to the cause of NIC

See item in the last (8th) edition of the college p.394

Anatomical pathology consistently reveals interstitial infiltration by cancer cells

Infiltration is due to mononuclear cells. The presence of granulomas can sometimes be observed (in the case of a corresponding etiology, e.g. sarcoidosis)

Glomeruli and vessels are most often preserved in the initial stages


Which of these proposals are urological causes of NIC?


Regarding NICs secondary to lithium intake:

30-45% of patients have functional renal abnormalities after 10-15 years of treatment


Anticalcineurins ( ciclosporin and tacrlimus )


Means Interstitial and Tubular Nephropathy with Urethritis

Is more common in adults than in children

Is interstitial nephritis associated with uveitis


Regarding fever in immunocompromised patients

Three therapeutic emergencies are identified: febrile neutropenia, asplenic fever, sepsis/septic shock

The presence of immunosuppression requires taking into account the possibility of opportunistic infection

Any febrile neutropenia requires emergency antibiotic therapy

The symptomatology of febrile neutropenia is poor due to the absence of phagocytic effectors

Any fever in an asplenic should be treated with probabilistic antibiotic therapy amoxicillin + clavulanic acid

Any fever in an asplenic should be treated with 3rd generation cephalosporin probabilistic antibiotic therapy (after blood cultures) because of the risk of fulminant pneumococcal infection


Immunosuppression has 3 consequences: the impossibility of setting up an adapted immune response vis-à-vis endogenous or exogenous infectious agents, reduced clinical signs making it difficult to assess the clinical severity that may be underestimated, the possibility of a more rapid multiplication of the infectious agent(s) involved

This is what makes diagnosis and management so difficult.

Any acute fever in an immunocompromised patient is a diagnostic emergency

Any acute fever in an immunocompromised patient is infectious until proven otherwise.

Neutropenia is most often secondary to cancer chemotherapy with a delay of onset of 2 to 10 weeks

Time to onset of 2 to 10 days depending on chemotherapy

The term neutropenia applies below 1000/mm3 neutrophils

The term neutropenia applies below 1500/mm3 neutrophils (PNN)


The infectious emergency is frank when PNN < 500/mm3

Febrile neutropenia is defined by PNN < 500/mm3 and fever

The most frequent bacterial translocations originate in the digestive tract

The 3 most common gateways are the digestive tract, skin and lungs

The clinical examination is often poor in a febrile neutropenic patient, because of the absence of inflammatory focus


Regarding infections in immunocompromised people

Fever is often the main, if not the only, manifestation of the infection

The presence of sepsis marks the absolute urgency and the need for prompt referral to a continuing care unit

Pleiocytosis is constant in CSF in meningitis

Leukocyteturia is often absent in urinary tract infections

The frequency and severity of infections are proportional to the depth of neutropenia

The risk of infection is significant if PNN < 500/mm3 and it is major if PNN < 100/mm3


We speak of tumor (in the onco MedLine) and, indeed, it is quite common

Independent clear fluid content (not communicating with the biliary tree)

They are hyperintense in T1 sequence MRI


It affects 0.1% of the general population

It is a fairly common tumor that affects about 3% to 5% of the population (3% in the MedLine of oncology, 5% in the college of hepato-gastroenterology)

On MRI, it is hyperintense in T2 with an increasingly intense peripheral lump filling towards the center


The pyogenic abscess is hyper-dense on CT scan with a central enhancement

The pyogenic abscess is hypoechogenic and hypodense on CT scan with peripheral enhancement

A serology of amoebiasis must be carried out at the slightest doubt

Hydatid cyst is caused by echinococcus fermantosus

Echinococcus granulosus (fermantosus is invented, it does not exist)

Alveolar echinococcosis is caused by echnicoccus multilocularis

Imaging in favor of sometimes invasive nodules, which can mimic neoplasia.


Metachrone metastases have a poorer prognosis than synchronous metastases

It's the other way around. Synchronous lesions can indeed sign a very weakened immune system

In general, metastases appear hypodense and do not rise to arterial time

If metastases appear within 8 years, in the context of a known primary tumor and imaging is considered compatible, the diagnosis is affirmed without recourse to biopsy

Within two years (according to the Oncology MedLine)

Biopsy is necessary if the patient has two primary cancers in their history


Regarding Hepatocellular Carcinoma (HCC):

It is the most common hepatic malignancy

Only in primary malignant lesions. Otherwise, it is mainly benign lesions (the simple biliary cyst affects almost 5% of the population). Also, there are more metastases than primary liver tumors.

HCC is more common in humans. The sex ratio is 6

The leading cause of HCC is hepatitis C virus

Atoxin gives hepatocellular carcinomas on healthy liver by causing p53 mutations

Any nodular image on cirrhosis is a CHC until proven otherwise.


Which of the following are benign tumors that do not require monitoring?

It has the potential for degeneration and can be complicated by bleeding, so it should be monitored.


Which of the following are risk factors for HCC?


What is the proportion of HCC occurring on cirrhosis?


Malignant epithelial tumors are the most common

Worldwide, stomach cancer is the fifth most common cancer

The average age of onset is 70 years with a female predominance

The most used histological classification is Lauren's which distinguishes 2 types of adenocarcinoma

The epidemiology of gastric cancer evolves differently depending on location and histological type


In France, stomach cancer is the second most common cancer

In recent years, there has been an increase in the incidence of cancers of the cardia and diffuse types

There is a decrease in the incidence of distal forms and intestinal adenocarcinoma

H. pylori is a gram-negative bacillus transmitted mainly in childhood


Autoimmune bullous dermatoses are very common diseases, especially in post-puberty women

Autoimmune bullous dermatoses (IBD) are a heterogeneous group of infrequent diseases with variable prognosis, often pejorative.

The diagnosis of IBAD requires a combination of clinical, pathological and immunopathological examinations

Desmosomes allow interkeratinocyte adhesion

the dermal-epidermal junction (JDE) is a morphologically complex region

There are two main groups of DBAI: supraepidermal and subepidermal

Intra-epidermal and subepidermal (there is nothing above the epidermis)


Intraepidermal DBAI are part of the pemphigus group

Intraepidermal IABDs are due to acantholysis

Desmosome alteration is caused by circulating PNNs

By autoantibodies "anti-intercellular substance"

A bubble is a superficial elementary fluid lesion larger than 15 mm

The bubbles sit exclusively on the skin coating

It can sit on the skin or mucous membranes


Regarding the clinic and histopathology:

Nikolsky's sign corresponds to skin detachment caused by friction on healthy skin

An acantholysis is an intraepidermal detachment

A subepidermal bubble by cleavage between the dermis and the epidermis is a tense bubble

The contents of a subepidermal bubble are clear or haematic

An intraepidermal bubble by detachment of keratinocytes from each other is a tense bubble

It is a flaccid and fragile bubble (because the roof of the bubble is very thin due to intraepidermal cleavage)


There is a list of known DBAI-inducing drugs

Bullous pemphigoid is an intraepidermal DBAI

Bullous pemphigoid (linear deposits of IgG and C3) is a subepidermal DBAI

ACE inhibitors are known inducers of pemphigus

Potassium-sparing diuretics are known inducers of bullous pemphigoid

The bubbles are stretched in the DBAI of the JDE


Like all mucous membranes, that of the nasal cavity is composed of three layers

The epithelium is composed of a cell monolayer

A chorion is composed of a single hypervascular layer

From the surface to the depth, there is the lymphoid layer, the glandular layer and the vascular layer


Regarding the vascularization of the nasal cavity:

Arterial vascularization of the nasal cavity is dependent on both carotid systems

These arterioles lack an internal elastic membrane

The artery of the subseptum vascularizes the anteroinferior part of the septum

The branches of the anterior ethmoidal remain independent from their birth to their passage through the microcirculation

The artery of the subseptum anastomoses with the artery of the septum and with the branches of the anterior ethmoidal

The vascular spot is an anastomosis area of three arterial systems


Kiesselbach's vascular spot is the main area of epistaxis

The venous system is distributed in three layers at the mucosal level

The veins of the nasal cavity have abundant anastomoses with the arterial system

Specifying the abundance and impact of epistaxis makes it possible to deduce the seriousness

It happens that if: trauma, taking anticoagulant/antithrombotic, etc.


Ensuring hemostasis is the first therapeutic act to consider

In benign epistaxis, the flow is scarce, dripping through the nostril, at first almost always unilateral

The appreciation of the bleeding volume is essential to find and guides all the care

The appreciation of bleeding volume is always difficult to estimate, frequently overestimated by the patient or the entourage but sometimes misleading by default because swallowed. Rather, it is based on the objective hemodynamic impact

The presence of bleeding disorders makes bleeding control more difficult

Severe epistaxis is frequently unilateral

Examination of the nasal cavities is sometimes delicate due to the abundance of bleeding, frequently bilateral and anteroposterior


An oral or injectable anxiolytic in an agitated and anxious patient may be proposed

The search for an etiology is urgent in the face of an epistaxis in progress

Drying up bleeding is the primary treatment

The examination of the nasal cavity will be performed using a rigid endoscope 0 or 30 degrees

Simple finger compression of the nose wing for 10 minutes can stop most epistaxis


Compression by hemostatic buffer is possible in first line

cauterization of the vascular spot is done in the operating room

cauterization of the vascular spot is done at the patient's bed

In case of undetermined localization, endonasal coagulation of sphenopalatine arteries is the first-line treatment

It is common to transfusion patients who have been victims of severe epistaxis

Exceptional transfusion Apart from massive loss and deterioration of the general condition, it is preferable to replenish the martial reserves (oral iron or injectable) or to offer treatment with erythropoietin (EPO)

An essential epistaxis of the young is treated by anteroposterior tamponade most often

Simple compression for 10 minutes. See cauterization of vascular spot


Which of the following propositions concerning epistaxis are true?

First-line treatment is based on digital compression for previous bleeding

Ethmoidal artery embolization is the third-line treatment

Embolization of the ethmoid artery is contraindicated because it is a branch of the internal carotid artery (ICA). Its embolization therefore exposes to a risk of stroke or occlusion of the central artery of the retina (blindness). A ligature is therefore performed instead.

Nasopharyngeal fibroid is a choanal vascularized tumor

True, it mainly affects boys at peripubertal age

Cauterization of the vascular spot is most often bilateral

Unilateral because risk of perforating the nasal septum if bilateral

The first measure to be carried out in case of severe epistaxis is the previous wicking

It is first necessary to perform a stripping because the clots, when they dissolve, cause even more bleeding


Parsnip is an infection of the soft parts of the hand or fingers

Phlegmon is an infection that develops in an anatomical space of the hand or fingers

Acute infections of the soft parts are monobacterial most often

The most frequently involved bacteria are oral streptococci


Which of these germs is, or is, responsible for impetigo?

Cocci gram + occurring in clusters (like all staphylococcus). It is facultatively anaerobic and has no coagulase. In particular, it can be found in infectious endocarditis on equipment.

Cocci gram + occurring in clusters (like all Staphylococcus). The treatment of choice is amox-ac. clav or C3G IV. Other antibiotics may work depending on the indication: fluoroquinolones, cotrimoxazole, macrolides, or glycopeptides (non-exhaustive list). It can cause many infections such as sinusitis, panaris, abscesses, bursitis, etc.

Cocci gram + presenting in diplococcus (like all streptococcus). It can be found in infectious endocarditis, rarely.

We see it, sometimes, in the impetigos. It is a gram + cocci presenting as a diplococcus (like all streptococci). It is also found in scarlet fever, tenosynovitis or panaris. It is a pyogenic germ, part of the Streptococci of Group A, which imposes additional contact precautions.

It is a gram + cocci in chains (like all enterococcus).


Which of these germs is, or is, most frequently responsible for boils?

Cocci gram + occurring in clusters (like all Staphylococcus). The treatment of thing is amox-ac. clav or C3G IV. Other antibiotics may work depending on the indication: fluoroquinolones, cotrimoxazole, macrolides, or glycopeptides (non-exhaustive list). It can cause many infections such as sinusitis, panaris, abscesses, bursitis, etc.

Coccy gram + presenting in diplococcus (like all streptococcus). It can be found in infectious endocarditis, rarely.


Which of these proposals about dacryocystitis are true?

Dacryocystitis is an infection of the tear sac

There is an unusual size of the inner corner of the eye

The edema caused can interfere with eyesight

The swelling can indeed generate the vision of the eye concern (internally)

It is rare in children and more common in the elderly.

It is often secondary to stenosis of the lacrimal glands


Which of these signs and symptoms can be found at the stage of collected parsnip?

These are the 4 cardinal signs of inflammation: edema, redness, heat and pain


Which of these treatment proposals is, or is, recommended in the case of collected parsnip?

At the phlegmasic stage, the treatment consists of antiseptic baths (+/- combined with antibiotic therapy depending on the case). At the collected stage, it is surgical excision and antibiotic therapy directed against staphylococcus.


The clinical examination • In all cases, the clinical examination, is the first fundamental step for the estimation of the severity and etiological orientation of respiratory distress

Cyanosis is rather predominant in the mucous membranes in case of circulatory cyanosis and rather at the extremities in case of breathatory cyanosis

Classically it is rather predominant in the mucous membranes in case of respiratory cyanosis (and called "hot") and rather at the extremities in case of circulatory cyanosis (and called "cold")

Blood gases will be taken arterial in adults

Blood gases will be collected from veins or capillaries in children and young infants without underlying chronic cardiopulmonary disease

Hypoxemia can only be analyzed on an arterial blood gas


– Hypercapnia will be observed during central neurological causes acting on the cerebral respiratory centers or during damage to the respiratory muscles

Any state of shock or severe infectious state may be accompanied by hypoxemia and therefore respiratory distress without pure respiratory cause found.

Foreign body of the child • Inhalation of foreign body mainly concerns children from 6 months to 6 years

Foreign body of the child • Inhalation of foreign body mainly concerns children from 6 months to 3 years, although inhalation can occur later and including in adults, sometimes giving tables of hypoxic cardiac arrest

A recurrent infectious pathology in the same territory and resistant to well-conducted treatment must evoke a foreign body of the respiratory tract and must discuss bronchial fibroscopy

• In case of doubt, on the inhalation of a foreign body bronchial endoscopy is the rule


Epiglottitis is an absoule life emergency and occurs after 6 months and can be seen until adulthood.

It has become extremely rare since vaccination against Haemophilus influenzae b (1st causative agent), to be sought at the interrogation of parents

Haemophilus microabscesses are responsible for inflammatory edema of the epiglottis

Typically, in case of epiglottitis the child refuses to lie down

• Antibiotic therapy with amoxicillin and clavulanic acid is urgent (50 mg/kg then 150 mg/kg/day)


Transport to hospital should be medicalized and tongue depressors should not be used in epiglottia

In case of intubation, she will have to be a child in a sitting position, more or less under fibroscopy, by a trained operator, with tracheostomy equipment available

Acute laryngitis is a common condition in the general population, giving a barking cough and a hoarse voice, linked to inflammation of the vocal cords

Acute laryngitis can cause expiratory dyspnoea in infants and young children

It can cause inspiratory dyspnea in infants and young children

It is exceptional before the age of 6 months, and must in these cases seek an underlying condition (laryngeal stenosis, subglottic hemangioma, other rarer conditions)


It is possible for some athletes to use certain treatments to manage an acute or chronic intercurrent health problem

The screening circumstances are set up by the HAS

Screening circumstances * set up by the AFLD, * carried out by a sworn person, * concerns all athletes participating in sports competitions or events, * collection of a urine sample, analyzed in an approved laboratory, * athlete's biological passport: hematological and endocrine module

One of the main objectives of doping is fatigue resistance

WADA will one day maintain the list of prohibited substances and methods


The World Anti-Doping Agency (WADA) annually updates a list of prohibited substances and methods, available annually

The French Anti-Doping Agency (AFLD) offers a search engine to check if a drug is banned

In France, almost 4% of doping controls carried out in 2012 contained prohibited substances (before verification of a possible ATU)

The Therapeutic Use Exemption (TUE) procedure allows certain athletes to use certain treatments to manage an acute or chronic intercurrent health problem

For diuretics, there is a need to deliver a TUE for any substance in or out of competition, in addition to that obtained for the diuretic


There are urinary thresholds for the latter beyond which it is not an intentional therapeutic use

A controlled pharmacokinetic study in athletes can confirm therapeutic use

Taking EPO may be associated with handling blood for doping purposes

The violation threshold is equivalent to a blood alcohol concentration of 0.10 g/L

For some sports if: aeronautics, automotive, karate, motorcycle, archery and powerboating


Gene doping is defined by WADA as "transfer of nucleic acids or nucleic acid sequences" and "the use of normal or genetically modified cells"

A direct screening measure is the verification of the drug-aided coat of arms

A direct measure: anti-doping controls. An untimely check of athletes' homes is of course illegal

Only professional athletes participating in a competition or event approved by a sports federation can be checked

Tests can take place during competitions but also during training for these competitions or events


This is a leg wound that has not healed for more than 3 months

Venous ulcer accounts for 80% of ulcer cases

The leg ulcer affects women prelaterially

In the case of venous ulcer, the measurement of the IPS is systematic

To look for arterial participation (IPS 0.7-0.9), which would constitute a mixed ulcer

To attribute an ulcer to an arterial cause, the ankle infusion pressure must be less than 30mmHg


The ulcer of necrotic angiodermatitis is very painful

In case of venous ulcer, venous and arterial Doppler ultrasound is systematic

Venous only. Arterial Doppler ultrasound is indicated in case of clinical suspicion of PAD (including abnormal IPS)

In the case of ABI between 0.7 and 0.9, the ulcer is mixed predominantly arterial

Mixed predominantly venous (PAD does not explain the ulcer)

Ecthyma is an infectious ulcer due to Staphylococcus aureus: it is small in size and occurs after a blackish crust

The ulcer is frequently complicated by atopic dermatitis


In case of ulcer, antibiotic prescription is systematic to avoid superinfection

No systematic antibiotic therapy: colonization is frequent and non-pathological

In the case of venous ulcer, cancerization is common and doubtless to be suspected in case of painful persistent ulcer

It is rare and late, but should still be mentioned, especially in case of pain or excessive budding on a chronic ulcer

Pellet transplantation is systematic in an arterial ulcer

Only in case of resistance to treatment for more than 6 months or larger than 10cm2

In case of ulcer infection, a silver dressing is indicated


Abnormal and/or involuntary movements are most often caused by motor prefrontal gyrus disorder

Abnormal and/or involuntary movements are most often caused by dysfunction, injury or degenerative pathology affecting the basal ganglia system (or basal ganglia) also called extrapyramidal system

The basal ganglia are responsible for programming and automatically executing learned motor sequences

Abnormal movements correspond to a disorder of programming and/or execution of movement

Abnormal movements have two characteristics: they are little or not controlled by the will and occur in the absence of paralysis (except in cases of associated involvement of the pyramid system)

The positive diagnosis of these abnormal movements is biological

The positive diagnosis of these abnormal movements is clinical, but the etiological diagnosis sometimes requires additional biological (including genetic) or imaging examinations


They are present at rest and disappear during muscle contraction only

They concern the distorted limbs, the lips or chin, and the head

They affect the limbs in distal, lips or chin, but never the leader unlike essential tremors

They are aggravated by emotions and mental arithmetic.

They are examined in a resting position (hands resting on a plane or on the thighs, palms facing up in a relaxed patient)


Wilson's disease can cause abnormal movement and parkinsonism

In case of parkinsonism related to an antipsychotic, it should be discontinued if possible and replaced if necessary by clozapine

A DaTSCAN® brain scan should only be performed if there is doubt between Parkinson's disease-related parkinsonian tremor and neuroleptic-related parkinsonian tremor

In practice, the DAT-scan can potentially be used for all problematic diagnostic orientations of parkinsonism syndrome.

If the diagnosis of Parkinson's disease is strongly suspected and it is an individual over 40 years of age, no further examination is necessary.

In case of parkinsonian tremors before age 40, a brain MRI and cupric workup including cupremia, ceruleoplasminemia and cupruria for 24 hours are necessary to rule out Wilson's disease.


The most common cause of postural tremor is parkinsonism

This is the case of parkisonian tremor. Essential tremor has a frequency of 6 to 12 Hz

Essential tremor is usually unilateral and asymmetric

The essential tremor is usually bilateral and symmetrical, with a frequency of 6 to 12 Hz, affecting the upper limbs, the leader

Action tremors are all willingly improved by alcohol intake but aggravated by emotions and caffeine.

This is the case of essential tremor. Not all action tremors are.

In case of doubt between a tremor related to Parkinson's disease and an essential tremor, a DaTSCAN® can be performed (it is normal in essential tremor), in order to help in the diagnosis and start a suitable treatment


Regarding essential tremor and cerebellar tremor:

Brain MRI is normal in essential tremor and should not be performed when the picture is typical

The most effective treatments for essential tremors are beta-blocker propranolol and barbiturate primidone

Cererebellar tremor is a tremor of action that appears or is maximum when arriving at the target

Cererebellar tremor is highlighted during action with intent

For example: the finger-nose test, drinking a glass of water, etc.

A walk with an enlargement of the lifting polygon evokes a cerebelous origin

There is also incoordination of movements


A diverticulum colon is an acquired hernia of the mucosa and submucosa through an area of weakness in the muscular wall of the colon.

The predominant localization is in the sigmoid colon

• Sigmoid or sigmoid diverticulitis corresponds to inflammation occurring in the vicinity of one or more sigmoid diverticula

There is a predominance in developing countries

Predominance in countries with a Western-style lifestyle

Uncomplicated diverticular disease is by definition asymptomatic, most often discovered during a colonoscopy performed for other digestive symptoms.


Regarding diverticulosis and diverticulitis

No treatment is needed for divertiuclose colic

The 2 possible complications are: • diverticulitis and its complications (peritonitis, abscesses, fistulas, strictures) and diverticular hemorrhage

Dietary measures are to be implemented to prevent diverticulitis

Abdominopelvic computed tomography is the key emergency test for the diagnosis of diverticulitis

the diagnosis of diverticulitis which is based on 3 associated signs: thickening of colonic aroi to more than 4 mm, infiltration of pericolic fat, presence of diverticula


Ultrasound, abdomen without preparation, MRI and opaque enema are not indicated

A residue-free diet is not warranted during the diverticulitis episode

One-third of sigmoid diverticulitis are complicated by abscesses

If the abscess is accessible and of sufficient size, its radiological drainage is indicated

In case of impossibility or failure of drainage, a resection-anastomosis, possibly protected by an upstream stoma, is indicated


Regarding diverticulitis and diverticulosis

Diverticular hemorrhages are often brutal, by erosion of arterioles of the collar or the bottom of the diverticulum

Diverticular hemorrhages are the cause of 60% of lower gastrointestinal bleeding

The cause of one-third of sudden lower bleeding of red blood

The diagnosis of diverticulitis is generally suspected in the presence of pain in the left iliac fossa accompanied by transit disorders, fever, elevated serum C-reactive protein levels and hyperleukocytosis

Diverticulitis, in its usual form, is treated with antibiotics for 7 to 14 days

Diverticulitis, in its usual form, is treated with antibiotics for 7-10 days

• In case of diverticulitis complicated by abscess, peritonitis, or fistula, management is conditioned by the general condition of the patient and the severity of the peritoneal infection assessed according to the Hinchey classification


You suspect an attack of sigmoid diverticulitis. Which additional exam(s) do you prescribe urgently?

The diagnosis must be confirmed by imaging

True. Allows diagnosis as well as to see complications (abscess for example)


Which of the following are true for headaches in SAH?

SAH (or subarachnoid hemorrhage) accounts for 10 to 30% of sudden headaches.

Typical headache is associated with other signs of meningeal syndrome

However, the headache can be isolated, more progressive, or disappear in a few hours, especially in case of HSA of low abundance (headache called "sentinel" of a ruptured aneurysm, preceding a massive SAH)


Which of the following are the tests you request as a first-line treatment when you suspect a subarachnoid hemorrhage?

True, this is the key diagnostic test. Its sensitivity is 95% on the first day

Absolutely contraindicated in the first intention by the risk of commitment


Which of the following are possible signs of subarachnoid hemorrhage?


Which of the following proposals regarding lumbar puncture in case of suspected subarachnoid hemorrhage are true?

The recrudescence of headaches would contraindicate the realization of the lumbar puncture

Does not fall within the contraindications of PL, which are: local infections, severe hemostasis disorders and intracranial hypertension with threat of engagement

The absence of xanthochromia of the fluid after 12 hours helps to eliminate a subarachnoid hemorrhage

True, xanthochromia is present in all aneurysmal SAHS when CSF is collected between 12 hours and 14 days after the onset of symptoms and analyzed by spectrophotometry.

The presence of a clear supernatant after centrifugation with the absence of blood pigment is in favor of a traumatic lumbar puncture

If imaging does not provide a diagnosis, a lumbar puncture should be done

Headaches from subarachnoid hemorrhage may fluctuate


Which of the following MRI propositions are true?

MRI becomes more sensitive than CT beyond 24 hours

True, it is then the FLAIR and T2* sequences that can detect hemorrhages

MRI eliminates subarachnoid hemorrhage at all stages

After 24h. Before, it is the scanner that is more sensitive

MRI allows an exploration of the intracranial arteries without injection


Vasculitis corresponds to an inflammatory involvement of the lymphatic vessels

Vasculitis typically only concerns blood vessels

There are no causes of secondary vasculitis

Bacterial, viral, iatrogenic, parasitic causes, etc. Note also the deleterious role of cocaine 💮

The Chapel Hill classification to differentiate between different vasculitis

True. X-ANCA with cathepsin G (PR, lupus) or lactoferrin (UC, sclerosing cholangitis) and p-ANCA with myeloperoxidase (MPA, Churg-Strauss, ...)


Green wood fractures concern the lower limb

The butter fracture affects the lower quarter of the radius

An unusual fracture may point to hyperthyroidism

Does not usually cause this type of fracture

An unusual fracture may point to osteogenic imperfecta


Which of these fractures are the most common in children?

Happens only in case of head trauma normally


Regional anaesthesia is contraindicated in children

It is to be dicutered (femoral block for example)

If fracture is suspected, the child should be left on an empty stomach

In anticipation of possible general anesthesia

The x-ray must allow to visualize the entire limb concerned

Not the whole limb, but systematically the over- and underlying joints

Radiography should include orthogonal incidences

Single incidence only in case of very painful obvious displaced fracture (single incidence, with subsequent additional incidences under anaesthesia)

Trauma to growth cartilage is radiotransparent


In the immediate postnatal period, most organs, except the heart and brain, are still in full development.

The clinical examination of the newborn is legally mandatory before the 30th day of life

The legal examination of the newborn ends with an interview with the parents

Anamnestic investigation is optional and reserved for complicated births

Maternal age below 18 years of age puts you at increased risk of prematurity