You receive in office, little Heathcliff, 1 1/2 years who presents an acute flare-up of atopic dermatitis. You decide to give some advice to parents...

True, this is THE thing to remember, no herpetic contagion with atopic dermatitis, it gives a Kaposi Juliusberg a very serious form!

Avoid herpes contagion at all costs, even in case of simple cold sores

False, entirely false, there are no contraindications on vaccines

Favor vaccines in periods of lull in the dermatological disease

True, and avoid wool or synthetic clothing

False, there is no allergenic eviction to do

Avoid nuts and exotic fruits, with high allergenic potential


Which of the following proposals are medical or paramedical professions with an order?


Which of the following propositions, is (are) true regarding fat embolism?

True. CLINICAL diagnosis above all and not paraclinical that will guide. If you ever miss the clinic, the fundus will allow a retrospective diagnosis

The diagnosis is primarily clinical and is based on the discovery of hyperthermia, sinus tachycardia and polypnea a few hours after a limb fracture

False. In addition there is only hypoxemia that is almost constant

The diagnosis is primarily paraclinical and based on the discovery of thrombocytopenia, hemolytic anemia and arterial hypoxemia.

True. It can be used to make a retrospective diagnosis when clinical manifestations have been missed.

The fundus can find retinal hemorrhages, cottony nodules and retinal edema

True! These manifestations are fickle, however.

The Gurd triad is based on the association of lesional pulmonary edema + neuro-psychic manifestations + petechiae of the trunk and mucous membranes

True! HEMODYNAMICS to be monitored extremely rigorously in the context of (poly)trauma. Fat embolism was the subject of an entire question at ECNI 2021. All this information can be found in the latest college of anesthesia resuscitation p344: https://www.cnear.fr/dfasm

Preventive treatment is based on immobilization of fracture foci, maintenance of good hemodynamics and the fight against pain


In the absence of effective breathing movements, what is the very first resuscitation maneuver to be undertaken in a newborn who is not screaming?

True, right after drying and stimulation

Nasopharyngeal aspiration and stimulation

Adrenaline administration is a last resort

If bradycardia persists despite effective ventilation

As a second line, after nasopharyngeal aspiration


The diagnosis of certainty of hepatomegaly requires:

True, ultrasound is necessary and sufficient


In 20% of cases, PD-NETs are revealed by symptoms related to hormonal secretion

Pancreatic adenocarcinoma is by far the most common pancreatic tumor (90%)

Endocrine tumours are the most common pancreatic tumour tumour

The average age of onset is between 60 and 70 years

In France, the incidence of adenocarcinoma of the pancreas has increased significantly over the past 20 years

Its prognosis is poor with a median survival between 6 and 9 months if the cancer is metastatic and 18 to 24 months if it could be resected

The prognosis for adenocarcinoma is very good, unlike neuroendocrine tumors


Which of the following proposals for acute renal failure and acute tubular necrosis is true?

Natriuresis in an NTA is increased

There is one exception though... NTAs secondary to rhabdomyolysis or iodinated contrast media: natriuresis has collapsed
For rhabdomyolysis, this is because there is volume depletion activating RAAS --> Na+ reabsorption
For iodinated contrast media I don't know...

No hypertension, no edema in the NTA! The clinical picture of the different ARIs is to know by heart!

Clinically we find hypertension and edema

In NTA, glomerular flow is decreased due to pre- and post-glomerular vasoconstriction and increased intra-tubular pressure.


Approximately how many doctors are there in France?

This is the approximate number of health professionals


Which of the following are the causes of motor diarrhea?


Which of the following are signs or symptoms of confusion?


What is the frequency of monitoring of endobrachyoesophagus between 3 and 6 centimeters?

Control every year (2 times in the first year) if low-grade dysplasia


Regarding immune deficiencies, among the pairs type of deficiency - opportunistic pathogens, which one or which are accurate?

True, humoral deficiency does not lead to opportunistic infections but to severe pneumococcus, meningococcal and haemophilus infections.

True, cellular immunodeficiency leads to parasitic, fungal, or viral opportunistic infections

Cell deficiency - opportunistic infections

True, we most often know meningococcal infections but it can also give serious sepsis

Complement deficiency - invasive bacterial infections

True, we know less about this subtlety but it's true

True, a specificity related to PNN deficiency

Phagocytic Deficiency - Pyogenic Infections


Folate deficiency is responsible for macrocytic anemia

A central cause causes normo- or macrocytic anemia

Spinal cord invasion gives microcytic anemia


Which of the following propositions concerning Vittel's algorithm in the context of polytrauma are true?

Extreme gravity is defined as a Glasgow at 3, a SBP < 65 mmHg and/or an SpO2 < 80% or impregnable

A fall from a height greater than 4 meters is an element indicating violent kinetics and the need for treatment in a specialized center

Another passenger who died in the same vehicle is an element indicating violent kinetics and the need for care in a specialized center

A pelvic fracture is an anatomical lesion requiring management in a specialized center

A patient with normal vital signs, no evidence of violent kinetics and no anatomical lesions requiring specialized management, but where the shockproof pants are inflated requires transfer to a specialized center.


Who are the actors involved in the system for reporting serious adverse events associated with care?

Healthcare professionals and healthcare facilities


Which of the following are segments crossed by facial nerve VII?

True. It emerges at the level of the stylomastoid foramen


When should vaccinations be performed in case of emergency splenectomy?

This is an emergency splenectomy (no time to wait 2 weeks)


Where does the facial nerve emerge from?

Emergence of the hypoglossal nerve XII (motor for the muscles of the tongue, passing through the hypoglossal canal)

Emergence of oculomotor nerve III (motor, innervates the upper right, lower right, inferior oblique, medial right, passing through the superior orbital fissure)


Which of the following propositions are true about the person of trust?

It only concerns patients with serious illness

The designation can be done on plain paper, signed and dated

Quite possible (especially if the doctor is not treating)

The designated person cannot be a doctor


Regarding allopurinol, what are the exact answer(s)?

False, it is 100mg per day, it is one of the only dosages that is required from you, because it is medico-legal

Allopurinol is to be initiated at a dosage of 200mg per day

False, as we will see below it is the DRESS syndrome. It is Febuxostat that has this type of side effects

One of the most serious side effects of allopurinol is the occurrence of digestive disorders

FALSE, +++ DRESS syndrome is a serious toxiderma and must always be suspected, especially with purveyor treatments such as Bactrim or Allopurinol!

A rash after taking allopurinol is common and mild

True, it is to start during symptomatic hyperuricemia

Allopurinol is to be started after the first attack of gout or first uricemic renal colic

True, they are both hyperuricemic treatments

When re-evaluating treatment, it is necessary to look for thiazide diuretics or loop in the patient's prescription


Mr MELARK, Peeta, 25 years old, comes to see you in general medicine consultation, because for a few months he has regular palpitations. He explains that he has already consulted a cardiologist who has ruled out all transient and extracardiac causes of palpitations and who would have vaguely told him about Bouveret's disease. He is very anxious because he is afraid of having "a cardiac arrest" like his uncle. What can you tell him about Bouveret's disease?

True, it is one of the two causes of junctional tachycardia with Wolff Parkinson White syndrome.

This is a not uncommon cause of junctional tachycardia in young people

False, these are the ECG features of Brugada syndrome, here in Bouveret's disease we find a fine QRS tachycardia with retrograde P waves

The ECG conventionally finds negative T waves in V1 and V2

False, another feature of Brugada syndrome. Bouveret's disease is benign and does not require defibrillation under any circumstances

There is a risk of cardiac syncope and the need for defibrillation

True, this is the typical symptomatology with pollakuria

The symptomatology is characterized by bouts of palpitations at the beginning and abrupt end

True, these are two lesser-known methods of vagal maneuvers but which are much easier than carotid massage or eyeballs.

A vagal maneuver by inverted Vasalva or ingestion of ice water can make the diagnosis


You receive in consultation Mr Deux, Ramsès, 75 years old, who is followed in pneumology for idiopathic pulmonary fibrosis. However, he also caught CoVID 3 weeks ago, and he can no longer distinguish between the symptoms of his long CoVID and idiopathic pulmonary fibrosis. What symptoms can you relate to his idiopathic pulmonary fibrosis?

True, quite simple this one, fibrotic patients present a dyspnea of effort becoming easier and easier with time, for an effort less and less important

False, it is a sign of influenza-like illness, so CoVID!

True, visible in both cases. Dry cough is clearly distinguished from fibrotic, unlike expectorant wet cough from COPD

False, grumbling is rather COPD! We find under crackling bases in fibrotic. To give you ideas, the ronchis is literally a "fouling" of the bronchi


What is the most common progressive complication of acute community-acquired pneumonia in children?

Post-pneumococcal hemolytic uremic syndrome

Hyponatremia by SIADH (syndrome of inappropriate secretion of anti-diuretic hormone)

False: This is the 2nd most common just after pleurisy ++


Regarding additional examinations in diffuse interstitial lung disease, what are the exact proposal(s)?

True, it is characteristic of diffuse interstitial lung diseases, the infiltration being "around" the structures where the air passes, it will compress the air and be restrictive

EFRs regain a restrictive ventilatory disorder

True, because of a lower respiratory volume, when there is an effort, the lung can not mobilize additional respiratory volumes

There is a classic desaturation on exertion

True, DLCO explores diffusion abnormalities between the alveolus and capillary transmitted by the interstitium. An abnormality of the alveolus (e.g. OAP), interstitium (PID) or capillary (HTP) can cause a decrease in DLCO

False, the so-called "honeycomb" cysts have a subpleural disposition

Honeycombs are cysts located in contact with the mediastinum corresponding to bullous structures within the interstitium

True, it is a highlighting of these anatomical structures, the septas

Lines or cross-links are accentuations of anatomical structures that are usually not visible


Regarding thrombocytopenia in pregnant women, what are the exact proposal(s)?

True, it's not noted in the college, but given the prevalence of obesity in the general population I think it's not bad for your patients to retain this as a potential cause.

Pregnancy NASH (Nonalcoholic Steatose Hepatic) is a cause of thrombocytopenia

Thrombocytopenia in pregnant women should be tested for HIV infection

True, it's in its name (Hemolysis, Elevated Liver enzymes, Low Platelets)

HELLP syndrome is a cause of thrombocytopenia in pre-eclamptic pregnant women

True, as in the general population, but here there is more often heparin treatment because of the prothrombotic risk

Prophylactic treatment with heparin may lead to thrombocytopenia

True, in >75% of cases it is physiological

The most common cause of thrombocytopenia during pregnancy is benign


You receive in hematology consultation, Mrs. EVANS Lucy, a 65-year-old patient who consults after he was found at the blood test a thrombocytopenia at 12G / L. Your colleague had performed a myelogram on this patient who found a marrow poor in megakaryocytes. What are the possible diagnoses in this patient?

Evans syndrome corresponds to peripheral autoimmune involvement of platelets and red blood cells. The patient has central thrombocytopenia with us

True, as with anemia, deficiency thrombocytopenia is central because it leads to a slowdown in central production.

False, chronic lymphocytic leukemia causes anemia and not thrombocytopenia ...

False, this is a "burst" of platelets in the blood, and not spinal cord damage

True, here cancer cells take the place of megakaryocytes in the marrow


Regarding purpuras, what are the elements suggestive of vascular purpura rather than thrombocytopenic purpura?

True, thrombocytopenic purpura is flat a contrario

True, it is also said that purpura is declivated, unlike thrombocytopenic purpura which are diffuse

False, the presence of hemorrhages rather indicates thrombocytopenia

Purpura associated with clinical bleeding

False, vascular purpura testifies to an attack of the small vessels with inflammation that leads to localized purpura, unlike thrombocytopenic purpuras which will be in sheets, because of an active hemorrhage.

True, purpura will be raised and palpable, unlike thrombocytopenic purpura


Regarding Hodgkin's lymphoma, which propositions are true?

True, in the young subject (about 25 years) and the elderly (about 80 years)

True, very good effectiveness of treatments

After treatment, about 90% of patients are cured

True, allows the Ann Arbor classification (which is not the case with Binet's classification in CLL, because the latter is a clinicobiological classification, which does not take into account imaging)

PET-FDG is systematic in the extension balance

False, the most common histological subtype in classical Hodgkin lymphoma is the scleronodular form (67% vs. 25%)

Mixed cellularity histological subtype is the most common form of classical Hodgkin lymphoma

The localized stage (I/II in the Ann Arbor classification) is most common at diagnosis


Regarding non-Hodgkin lymphomas, what are the real proposals?

False, T/NK lymphomas account for only 15% of non-Hodgkin lymphomas

The majority of non-Hodgkin lymphomas are T-cell lymphomas

True, it is a diffuse large B-cell lymphoma (CD20+, CD 10+, bcl-). It evolves very quickly (aggressive). There are endemic (African), sporadic (non-African) forms and linked to immune deficiency.

EBV infection is a risk factor for Burkitt's lymphoma

One of the most common non-Hodgkin lymphomas is diffuse large cell B-cell lymphoma

False, compressive syndrome is more common in non-Hodgkin lymphomas

Compressive syndrome is less common than in Hodgkin's lymphoma


Which of the following propositions about malignant lymphomas are true?

False, they are characteristic of Hodgkin lymphomas

The presence of Reed-Sternberg cells is characteristic of non-Hodgkin lymphomas

True, acquired or congenital immunosuppression

The immunosuppression field promotes malignant lymphomas

False, the diagnosis is based on lymph node biopsy because histological proof is absolutely necessary

Diagnosis of malignant lymphoma is based on lymph node aspiration

Superior cava syndrome is a therapeutic emergency

True, to be carried out after agreement of the patient!

Always think about performing an HIV serology


Regarding agranulocytosis, which propositions are true?

True, especially during a control blood count

False, this is extrinsic accountability. The intrinsic imputability of agranulocytosis to a drug is based on semiology and chronology

The method of intrinsic imputability of agranulocytosis to a drug is based on pharmacovigilance data

False, the elevation of PNN occurs 48 hours after the appearance of monocytosis

The appearance of monocytosis during follow-up is suggestive of the elevation of ANCs within 24 hours

Treatment is based on broad-spectrum antibiotic therapy even in the absence of fever


Which of the following are true about zoledronic acid?

It is a drug for the prevention of complications of bone metastases

It is a bisphosphonate inhibiting bone resorption related to osteoclastic activity

It is injected in slow IV every month or so.

There is a risk of osteonecrosis of the jaw and hypocalcemia


Which of the following proposals designate cystic tumors of the pancreas that do not develop within the pancreatic ducts?

They develop within these channels themselves.


In secondary amenorrhea, a low LH, FSH and estradiol assay points to an ovarian cause

False, these results point to gonadotropic insufficiency (central origin)

A beta hCG test is essential when looking for the etiology of secondary amenorrhea

True, to eliminate pregnancy, physiological cause of amenorrhea

FSH assay is found collapsed in amenorrhea with PCOS as an etiology

To explore gonadotropic insufficiency, a pituitary MRI is performed


Regarding thyroid goiters, which propositions are true?

If the TSH test comes back high, anti-TPO antibodies are dosed.

True, to look for Hashimoto's autoimmune hypothyroidism

If the TSH test comes back high, anti-TSH receptor antibodies are measured

False, anti-TSH receptor antibodies are dosed if the TSH dosage comes back low, to eliminate Graves' disease

De Quervain's subacute thyroiditis is a cause of goiter

A goiter can progress to thyroid cancer in 15% of cases


Regarding thyroid nodules, what are the true propositions? (one or more true propositions)

Nodule size is synonymous with malignancy

False, the size does not presume the malignancy of the nodule

The first-line examination in thyroid imaging is the scintigraphy

False, the 1st intention examination is ultrasound

The determination of calcitonin is always recommended in the first-line assessment when a nodule is discovered

False, it must be practiced systematically in certain situations only: known hereditary context of medullary thyroid cancer, if suspicion of malignancy of the nodule at cytopuncture and before any intervention for goiter or nodule

A nodule with a score of 2 on the Bethesda cytological classification is a malignant nodule

The course of action for a Bethesda 6 non-functional nodule is surgery


Regarding thyroid cancers, which proposals are true?

Recurrent paralysis may be a clinical sign allowing the revelation of a thyroid nodule

The most common vesicular carcinomas are differentiated vesicular cancers

False, they represent only 5% of thyroid cancers. The most common is differentiated papillary carcinoma (85% of cases)

Anaplastic carcinomas require urgent management

Medullary thyroid cancers develop at the expense of calcitonin-secreting C cells

Medullary thyroid cancers can integrate into multiple endocrine neoplasia type 2 (MEN2)


Insulin intermediate (NPH) is a suspended insulin (powder) that needs to be reconstituted

TRUE. NPH insulin is a powdered intermediate insulin that is injected subcutaneously

Rapid insulin works in 15-30 minutes and lasts about 4-6 hours

TRUE! - Rapid insulin: Acts in 15-30 min and lasts 4-6h
- Slow insulin: Acts in 1-2h and lasts 24h = "insulin to live"

TRUE! Page 280 of the new college (5th edition). Rapid insulin exists in IV/IM/SC/pump form

TRUE, unlike the fast one that acts in less than 30 minutes. Its action lasts 24 hours

A type 2 diabetic with HbA1c > 10% and cardinal syndrome will immediately require insulin treatment

TRUE! Overall here, the patient is unbalanced (HbA1c > 10%) with clinical decompensation (cardinal syndrome). This is an indication to introduce insulin from the outset


In France, the prevalence of obesity is around 15%

Obesity prevalence declines after age 65

The mutation of the melanocortin receptor would be responsible for less than 5% of severe obesity


What element(s) are complications of obesity?


What examinations are systematic in the face of obesity?


A new patient comes in for consultation and asks you for surgical care. You explain the conditions according to the HAS. Check the true answer(s):

Need for management and follow-up of at least 6 months before

Possible under certain very strict and exceptional conditions


What comorbidities are improved by surgical management of obesity?


What are the contraindications to bariatric surgery?

Prolonged medical follow-up not feasible


There are 2 consecutive phases in Guillain Barré syndrome

Up to 1 year and a half (18 months). Patients are then hospitalized for a long time (often in MRP wards). After 18 months, the lesions are considered fixed

This is the second phase. It can last up to 3 weeks


What percentage of patients have permanent sequelae (motor deficit, ataxia) of Guillain Barré syndrome?


Which of the following are PSRs for treating physicians?


You are a medical gynecology intern and you receive today Mrs. Z 28 years old to perform a cervical smear as part of cervical cancer screening.
She has the following background:
- type 2 diabetes,
- a Helicobacter pylori infection treated 2 years ago,
- a solid organ transplant under immunosuppressive therapy since the age of 24.
A few days after the consultation you receive the result of the smear: ASC-US.  What is the exact proposal(s)?

An HPV-HR test should have been performed as a first-line test before smear cytology.

Fake the patient at 29 years old and cytology on FCU must be performed in first line between 25 and 30 years!

Following the result of the smear, an immediate colposcopy should be performed.

False! If AUC-US = indeterminate = HPV test, if the latter is positive then a colposcopy will be done, otherwise a cytology at 1 year.

Annual cervical cancer screening is recommended for this patient as part of a specialized follow-up.

True she is on immunosuppressant +++ = increased risk of cervical cancer or rapid progression to cervical cancer after HPV infection!

Type 2 diabetes is a risk factor for cervical cancer.

False! Risk factor for endometrial cancer!

If the smear result had been: LSIL, colposcopy would have been indicated.


What are the risk factors for gastric adenocarcinoma?

False, it is a risk factor for esophageal cancer

True, because partial gastrectomy leads to stagnation of stomach contents in the stump, which will lead to an additional risk of cancer. This is why we do control fibroscopies in the follow-up of sleeve (at 2 and 5 years)

True, i.e. salt and nitrites, which partly explains why low socioeconomic status is also a risk factor

True, because like all gastritis there is inflammation and therefore a risk of cancerization

Presence of chronic GERD for more than 20 years


You receive in digestive oncology consultation Mr RAT, Paddy, 75 years old that you have brilliantly operated on a gastric adenocarcinoma, via a total gastrectomy. You will now explain the necessary elements for the rest of the support

Meal splitting (6 to 7 meals per day in small quantities)

True, simply the stomach can not hold more food, so to avoid dilating the stump, we split the meals

False, some surgeons can do it, but there is no clear indication.

Taking carbohydrates every 2 hours to avoid dumping syndrome

False, completely fanciful! Dumping syndrome corresponds to hypoglycemia related to the delay in the absorption of carbohydrates in the body (basically the pancreas detects carbohydrates in the stomach, and secretes insulin when we have not even sent carbohydrates into the blood, to schematize roughly that's it)

Antiplatelet therapy for a period of 6 months

False, no antiaggregant necessary except possibly in case of postoperative hyperplatektosis and still it is discussed.

Wrong, big trap! It's intramuscular!!! You no longer have a stomach so you can no longer absorb Vitamin B12... (even if you will see that the literature retains that we can supplement PO anyway, but not to ECN)


What are the signs on pelvic ultrasound of an ovarian tumor in favor of malignancy?

False, it is seen in particular in the hormonal stimulations of ART, to ovulate many oocytes to the patient

True, it often indicates contralateral and advanced involvement

True, vegetations are often signs of cancer

False it is a central hypervascularization


Mrs. DAPHNIS, Chloé, 75 years old, comes to consult you in oncology appointments, because she has just been diagnosed with ovarian cancer. Very familiar with item 303 of the ECN, she asks you questions about the BRCA1 and BRCA2 genes that are predisposing to ovarian cancer. What can you say to him?

False, these are tumor suppressor genes! Generally oncogenes are autosomal recessive and autosomal tumor suppressor genes dominant, I remembered like that!

BRCA 1 and BRCA 2 genes are inherited in an autosomal dominant manner

True, it is enough to have only one mutated to express the disease

There is a higher risk of developing ovarian cancer when you have mutated BRCA1 compared to mutated BRCA2

True, up to 50% for BRCA versus 25% for BRCA2 (versus about 12% in non-mutated women, and 6% in the general non-mutated population)

Any diagnosed ovarian cancer requires testing for mutated BRCA

True, cancer so rare that it requires genetic research (Lynch and / or BRCA often involved)

For mutated BRCA, treatment for ovarian cancer is based on targeted monotherapy

False, there are many targeted therapies with PARP inhibitors but they are in addition to chemotherapy.


For biopsies of primary and secondary bone cancers, what are the exact answer(s) among the following?

Bone biopsy is an essential act for the characterization and diagnosis of primary bone tumor

True, as with almost any cancer! The biopsy is the heart of diagnosing the type of cancer (primary, secondary) and its grade

In case of suspicion of primary bone cancer, a Multidisciplinary Consultation Meeting must take place, but the latter must be approved of its specialty in primary bone tumors

True, completely convoluted sentence, to say that, since these are rare tumors, CPR must be done in a reference center in the field

Biopsy samples will be frozen and copies will be stored in the tumour database

True, as these are rare tumors, they must be frozen to be references and benefit from additional analyzes

Biopsy alone can diagnose the severity grade of primary bone cancer

True, the gradification of cancer severity is based on cyto and histological elements, so the biopsy alone makes the grade

High-grade osteosarcoma is more deadly than high-grade chondrosarcoma

False, both almost always fatal at 5 years, distractor because it was necessary one


Which of the following are primary bone tumours?

True, to retain malignant tumors benign tumors for bone tumors there is a small and very simple way, namely, all tumors that end in sarcoma or that include sarcomas are malignant tumors (bone sarcoma, leiomyosarcoma, osteosarcoma, Ewing's sarcoma, chondrosarcoma). Everything else is benign

False, small trap this tumor does not exist


Regarding biopsy in the context of lung cancer diagnosis, what are the exact answer(s)?

The biopsy is done under general anesthesia

False, it can totally be considered under local anesthesia

The biopsy is done with a rigid bronchoscope

False, a flexible bronchoscope is indicated to allow better passage through the bronchi

The performance of the biopsy is improved by the realization of a cytological brushing and / or a directed lavage for cytological aspiration

True, it allows for additional cytological analysis and that's just a bonus.

In some cases, cytological analyses of sputum may point to the type of tumor

False, there is no indication and no interest in performing it

Transparietal needle puncture-biopsy is at risk of pneumothorax

True, logically, the pleura is on the way


You are a general practitioner, and you receive Mr PARKER, Peter, 76 years old, for his prescription renewal.
This former repairman on the shipyard, smoking like a firefighter, with a smoking rated at 180PA is at risk of lung cancer. You regularly screen for lung cancer, monitoring its respiratory signs and doing repeated imaging tests, but your external who attends your consultation tells you that you must also watch for paraneoplastic syndromes in this case too...
What paraneoplastic syndromes can be found in lung cancer?

False, this febrile neutrophilic dermatosis is found mainly in hemopathies, and in no case in lung cancers.

Syndrome of inappropriate secretion of anti-diuretic hormone

True, or ex-Schwartz Barttner syndrome, it is characterized by deep hyponatremia

True, or Pierre-Marie syndrome, it will be characterized by a digital hippocratism and pain of the joints of the limbs, with imaging an engainant periodosis.

True, it mimics in every way a myasthenia gravis except that we will not have the antibodies!

False, this hepatomegaly with anicteric cholestasis is found in kidney cancer


You receive in consultation Mr HARKNESS, Jack, 67 years old, completely panicked! Indeed he tells you that his "PSA is much too high" and he thinks he has prostate cancer. You try to reassure him by explaining the possible causes of PSA elevation... What are they?

True, the prostate is bigger, so it produces more PSA! 1ng/mL per cm3 of prostate (volume assessed on MRI)

True, testosterone stimulates prostate cells and therefore the production of PSA

True, prostate irritation transiently increases PSA levels

True, unknown cause, absent from several referentials, but that we must know. Simply because ejaculation stimulates the prostate for protein secretion and therefore stimulates the production of pSA


Regarding the prognostic classification of prostate cancer and the appropriate therapeutic options, validate the corresponding couples.

True, for low risks the possibilities are active surveillance, brachytherapy, radiotherapy, prostatectomy

False, for high risk the only possibility is radiotherapy and hormone therapy for 3 years, or total prostatecomia + lymph node dissection as part of a multimodal treatment

Moderate risk - Radiation therapy and hormone therapy for 3 years

False, for moderate risk the possibilities are prostatectomy and radiotherapy with hormone therapy for 6 months

False, treatment of resistant or metastatic forms


What are the hereditary forms of kidney cancer?

True, one of the two hereditary forms to remember for the ECN, sorry to make a MCQ on it, but it is a small detail to have in mind for a fifteenth question

False, this pathology is at risk of digestive cancer

False, does not exist, but remotely resembles Fitz-Hugh-Curtis syndrome, which corresponds to perihepatic violin strings in advanced C. Trachomatis infections.


What are the risk factors for adenocarcinoma of the esophagus?


True, risk factor for all types of esophageal cancer


What are the possible markers of neuroendocrine tumors?


Adenocarcinomas are classically TTF1 positive

Adenocarcinomas are classically p40 negative

TTF1 stands for: Thyroid Transcription Factor-1

It is relatively specific to squamous cell carcinomas


What is the overall 5-year survival in percentage for all tumours?


True, there are two lobes (upper and lower, distinguishable with the sign of the cardiac silhouette) separated by a "large" split

There are three splits: one large, one medium and one small


Oxaliplatin is used in colorectal cancer

Especially oxaliplatin which gives neuropathies in the cold


What is the leading cause of facial paralysis?


The severity of acute hepatitis is based on the value of transaminases

False: The assessment of the severity of acute hepatitis (HA) is based on clinico-biological signs reflecting a functional impact: the value of TP and/or factor V (hemostasis disorders) and the presence of signs of hepatic encephalopathy (severe prognosis).

A PT < 50% requires hospitalization of the patient in a specialized center close to a liver transplant center

True: acute hepatitis with < PD  50% corresponds to severe HA and requires hospitalization in a specialized center.

The definition of fulminant hepatitis is based on the association of a PD < 50% and the installation of hepatic encephalopathy

True. HA fulminant = TP < 50% associated with signs of hepatic encephalopathies of recent onset < 2 weeks.

Sub-fulminant hepatitis develops within less than 2 weeks

False. HA fulminant = installation < 2 weeks. Sub-fulminant HA = installation 2 weeks-3 months.

All acute hepatitis occurring on a cirrhotic liver is acute alcoholic hepatitis.

False. Acute alcoholic hepatitis is a diagnosis to look for but all causes of acute hepatitis can occur in a cirrhotic patient!


What are the true propositions concerning hypertransaminasemia?

There are extrahepatic causes responsible for elevated BP

True. These are the differential diagnoses to keep in mind: celiac disease, myopathies, hemolysis, heart damage, violent efforts.

The two main causes of BP < 10N (low to moderate) are drug-induced and viral hepatitis.

False. The two main causes of BP < 10N: alcohol and metabolic syndrome.

Hepatic ultrasound is part of the etiological assessment in front of acute hepatitis with BP > 10N.

True. 4 causes to look for acute hepatitis with BP > 10N: viral (=serologies+++), drug/toxic (paracetamol+++), lithiasis (echo+++) and hepatic hypoxia (Budd Chiari, Heart failure, shock...)

Acute hepatitis with a fever > 38.5 should be investigated for acute herpes hepatitis.

The majority of viral algae hepatitis is clinically characterized by Caroli's triad: headache, arthralgia, urticaria.

False. The majority of acute viral hepatitis is ASYMPTOMATIC.


Which germs are gram-positive cocci in chains?

True, all streptococci are chained at ECN


You have in hospital, Mr. Langdon, Robert, 55 years old, who presents for a gout attack occurring on his right knee. Which of the short-, medium- and long-term treatment options will you remember?

True, all non-drug measures are to be preferred because we can always take advantage of them

Colchicine started on the second or third day of hospitalization at a maximum dose of 3mg, to take advantage of the decrease in infection

False, colchicine is to start as early as possible, because it is all the more effective

In case of macrolide treatment for digestive infection, there is a contraindication to NSAIDs

False, a contraindication to colchicine, due to the interaction with cytochromes

The therapeutic target of hypouricemic treatment is 360micromoles per liter

True, which corresponds to the crystallization threshold of sodium urate

The patient will have to curb his consumption of alcohol, fast sugar and offal


What is the chemotherapy of choice for lung tumors?

No, especially since it has pulmonary toxicity type of pulmonary fibrosis


Regarding imaging in the diagnostic assessment:

ATTENTION: the question concerns the DIAGNOSTIC assessment (and no extension)...

To speak of a systematized abnormality, the lesion must be extended to an entire lobe or lung segment

Mediastinal lymphadenopathy can easily be confused with blood vessels

In the extension assessment, we do a TEP. But not in the diagnosis


Which of these proposals designates the most common histological type of malignant renal tumor?


Mr. Williams, Rory, 45 years old, overweight, with a BMI of 27 comes to see you for consultation because "Enough is enough, I want to eat better!". He asks you what he should actually do as a meal and what portion of each food he should put on his plate. What do you say to him?

All-you-can-eat water during and between meals

False, starchy foods are "solid", this is what allows you to stall during meals, so it is to be private for lunch and dinner

True, public health message that everyone knows ;)

Focus on vegetable fats and saturated fatty acids

False, small trap here to insist that it is INsaturated fatty acids that are to be preferred (vegetable fats) rather than saturated fatty acids (cold cuts etc ...)

False, recommendation that has been revised downwards, due to a highlighting of dairy lobby, currently it is 2 per day that is recommended for adults


Regarding dietary modifications recommended in common clinical situations, what are the following exact pathologie/dietary recommendations?

Hypertriglyceridemia and Decreased consumption of simple carbohydrates and alcohol

True, we sometimes make a false amalgam between triglycerides = eat fat, but it is especially sugar and alcohol that causes a peak of hypertriglyceridemia

Osteoporosis and increased vitamin calcium intake

True, in a very logical way, a vitaminocalcium intake improves bone remodeling

Gastroesophageal reflux disease and limitation of alcohol, chocolate and coffee consumption

True, quite logical there too, these are hot drinks that can irritate the esophageal mucosa and promote reflux

Irritable bowel syndrome and diet with FODMAP exclusion

False, quite important point, because if the FODMAPs-free diet has been quite popularized lately it is a very very restrictive diet (with exclusion of many foods) which is very restrictive and which should only be considered in case of drug failure and failure of other dietary care.

Diverticular disease and residue-free diet

False, it is that in the case of acute diverticulitis that a diet without residues is prescribed.


Freshly appointed intern in geriatrics in the department of SSR Geriatric of your municipality, you receive in your department Mr Dicarpaccio, Leonardo, 89 years old, hospitalized for 1 week in acute geriatrics for fall with prolonged ground station, complicated bedsores. You look at the file with your senior and you notice that he has not eaten for 1 week. Your boss then tells you at 5pm to prescribe nutritional supplementation while paying attention to inappropriate renutrition syndrome. Thoughtful, you plunge back into the characteristics of this syndrome. What are the clinical and biological signs and what prevention should be applied in case of risk of this syndrome?

The syndrome can manifest as edema of the lower limbs

True, edema of the lower extremities is a clinical sign of severe undernutrition, but also a sign of inappropriate renutrition. In short, watch the legs of your at-risk patients!

Biologically, the syndrome is manifested by hypophosphoremia, hypomagnesemia, hypokalemia

True, the cause of inappropriate renutrition syndrome is an acute consumption of electrolyte reserves provided by the diet, namely phosphorus, magnesium, potassium.

In case you decide to implement parenteral nutrition, you should adapt the flow of the nasogastric tube starting at a low flow rate.

False, small trap (because I have often been fooled...) everything is true except that it is ENTERAL nutrition

Routine phosphorus supplementation of at-risk patients is sufficient to correct phosphorus deficiencies and dispenses with follow-up biological assessment

False, preventive supplementation is not like its name... that preventive and does not dispense with biological monitoring every two days of phosphorus

Regular weight gain in the first days of renutrition is reassuring

False, rapid weight gain will most often testify to edema of renutrition raising fears of an inappropriate renutrition syndrome.


Which of the following pathologies are causes of weight loss with hyperphagia?

True, it is even part of the diagnostic criteria for type 1 diabetes. Weight loss with polyphagia

False, there is most often a deficiency of intake related to swallowing disorders

False, there is most often a normal diet, but with deficiencies.

True, Épinal's image of hyperthyroidism shows a skinny woman eating a lot but losing weight!

True, since it is the worm that eats everything in the patient's place, the patient is naturally hungry!


1 gram of carbohydrate corresponds to how many kcal?

True, 1g Carbohydrate and protein = 4 Kcal


1 gram of fat corresponds to how many kcal?


You receive in the emergency room, Zenigata, Koichi, 45 years old, a man brought by the PASS, who explains to you that it is a homeless man who spends most of his nights outside. On clinical examination, you notice a perifollicular petechial purpura, as well as many oral hemorrhages with thickening of the gums leading to dental loosening. What pathology do you suspect?

False, Osler's endocarditis would be evoked before a fever with conjunctival purpura.

False, it is manifested by ligament and cutaneous hyperlaxity with healing disorders

True, here the context of homelessness is favoring vitamin C deficiency. The clinical description shows facilitated bleeding with hyperinfiltration of the gum mimicking a hematological disease with loosening of the teeth.

False, it is manifested by a hematoma in glasses


You receive in general medical consultation, Mrs. Kyle, Selena, 37 years old, who comes to see you for a table of various gastroenterological symptoms (abdominal pain, bloating, diarrhea), which you attach to a possible irritable bowel syndrome. The very concerned patient asks you if she should have a colonoscopy. To answer his request you explain the different indications of colonoscopy in the context of irritable bowel syndrome.

History of colorectal cancer in the father

True, it is quite logical, generally faced with a history of colorectal cancer, we are not cautious, patients usually have an endoscopic examination to eliminate adenomas, polyps and cancers.

True, because we join the, the limit of standard screening. Overall, a complete colonoscopy is done to reassure that the symptoms are of functional origin

Alternating diarrhea constipation at the level of the clinical picture

False, symptom intensity (except recent modification) does not count in the decision criteria for colonoscopy

True, very logically, irritable bowel syndrome does not give rectal bleeding


It corresponds to a renal failure of functioning origin that does not correct itself despite maximum management

It appears at an early stage of cirrhosis

It is most often observed in cases of severe liver failure with significant ascites and a prothrombin level still above 50%

The long-term treatment is terlipressin and adrenaline

These are treatments whose beneficial effect is only temporary. The only long-lasting treatment is liver transplantation

It may be responsible for hepatic encephalopathy


What are the triggers of hepatic encephalopathy?


Presence of a spontaneous portosystemic shunt

Not a triggering factor in itself (but bacterial infection is one), so it's not a direct link (so not to check)

Not a triggering factor in itself (but digestive bleeding is one), so it's not a direct link (so not to check)


You take care of a patient who complains of a "bloated belly".

On clinical examination you find: 130/90 mmHg, 75 bpm, apyretic, 99% in ambient air, G15.

NEUROLOGY: the patient is calm, conscious and oriented. You do not find abnormalities in the cranial pairs or other focal neurological deficits. ROTs are normal. No asterixis found, no tremors of the extremities.

CARDIOVASCULAR: Heart sounds are regular without breaths, no signs of left or right heart failure. Peripheral pulses are perceived, no abdominal beating mass.

ABSTATIC: the abdomen is tense, depressible and painless. BHAs are correctly perceived. You find a hepatomegaly of hard consistency. No perceived splenomegaly. Presence of abdominal collateral circulation. Presence of dullness declive on percussion. Hernial orifices are free.

MUCOSAL CUTANEOS: stellar angiomas, white nails, palmar erythrosis.

What are the exact proposals?

You suspect hepatocellular insufficiency

True, in front of stellar angiomas, white nails, palmar erythrosis

True, in front of the tense abdomen and declivated dullness (= ascites) and collateral venous circulation

You suspect thrombosis of the inferior vena cava


Conjugated bilirubin jaundice is always due to biliary stasis

Many other causes of increased conjugated bilirubin exist. For example, large hemolysis leads to functional cholestasis

Conjugated bilirubin jaundice causes dark urine

Free bilirubin jaundice is conventionally accompanied by clear urine

Free bilirubin jaundice does not conventionally cause pruritus

free bilirubin is eliminated in the urine

It is transformed by hepatocytes, which eliminate it in the bile


A 70% post-bronchodilator FEV1 classifies COPD as stage:


A 10% post-bronchodilator FEV1 classifies COPD as stage:


A 90% post-bronchodilator FEV1 classifies COPD as stage:


A 55% post-bronchodilator FEV1 classifies COPD as stage:


How many possible stages are there in the COPD GOLD classification based on post-bronchodilator FEV1?


What are the risk groups for C virus infection?

Subjects who received blood or blood derivatives before 1992

Subjects originating from a hyperendemic area


Adrenal tumors may be a differential diagnosis

The diagnosis of splenomegaly is mostly ultrasound

Hypersplenism can cause thrombocytopenia

Viral hepatitis be a cause of splenomegaly

A splenic infarction can be revealed by left basithoracic pain associated with hyperthermia


What are the secondary causes of carpal tunnel syndrome?

It is a primitive cause (and not secondary, so does not answer the question) 😊


What parasitosis is associated with eosinophilia?

True, the purpose of this hyper catalog MCQ is twofold: knowing which parasitosis give eosinophilia is hard and complex, better to remember those that do not: Malaria, Giardiosis, Amoebiasis. In addition, it also makes it possible to remember which parasite is associated with which disease.

False, amoebiasis does not give hypereosinophilia.

True, cf A. echinococcosis gives eosinophilia

False, giardiasis gives fatty diarrhea after returning from travel


Cervical lymphadenopathy drains the following territories:


Supraclavicular lymphadenopathy drains the following territories:


Axillary lymphadenopathy drains the following territories:


Inguinal lymphadenopathy drains the following territories:


You have in geriatric hospitalization, Mrs. Everdeen, Katniss, 85 years old, hospitalized for a "difficult home support". During your careful clinical examination you will highlight multiple venous lower limb ulcers. The nurse of the service then asks you "what to do", what do you decide to do as local treatments?

For ulcer cleansing, you prefer the use of hydrogen peroxide after careful antisepsis

False, the "washing" of ulcers is done with simple water, antisepsis is a mistake because it will promote more than prevent infections, by modifying the skin flora. It has an indication only in case of bacterial dermohypodermatitis

To promote skin budding, you use vaseline tulle with lanolin or Peruvian balm

False, then we use vaseline tulles or "greasy dressings" to bring material to the skin to rebuild, but we must avoid in all cases the use of allergens such as lanolin, Peruvian balsam, fragrances, which can lead to contact dermatitis

Hydrocolloid or hydrocellular is a type of dressing that brings "fat" to the wound, promoting budding

False, as seen above, it is the vaseline tulles that have this role. Hydrocolloids are moist dressings with optimal pH that promote budding, through controlled maceration.

Silver dressings are not systematic in the management of ulcers

True, to use only in inflammatory ulcers at risk of becoming infectious

In the case of this patient, in the absence of PAD with IPS <0.7 venous compression will be systematic


Regarding ulcers, what are the main complications of the latter?

True, this is the main complication to look for, it is a wound that can be the gateway to an erysipelas

True, poorly known, but it is a diffusion of inflammation at the level of the underlying periosteum

True, just like protein malnutrition it is a complication to think about in front of any wound, especially in the elderly and dependent

Hemorrhage mainly in the context of an arterial ulcer

False, hemorrhage is mainly observed in front of venous ulcers and not in front of arterial ulcers

Squamous cell carcinoma in front of a chronic ulcer

True, existing chronic complication in front of a resistant chronic ulcer


Which of the following are NOT indicators of secondary Raynaud's phenomenon?

The factors that are in favor of a secondary Raynaud and to know are: male sex, age of onset > 40 years, unilateral involvement, involvement of the thumb, absence of pulse, abnormal Allen, trophic disorders, absence of summer remission, photosensitivity and presence of mega-capillaries to capillaroscopy. As a P1 DOUBLE WOULD SAY: BY PRIMING HEART!


Where is IGF1 mainly synthesized? (> 50% of production)

True. IGF-1 production is virtually ubiquitous, but the main producing tissue is the liver (more than 50% of plasma concentrations)


What are the complications of acromegaly to look for?


What proposals are true about the by-pass?

Vitamin supplementation lasts 6 to 12 months, while the rest of the intestine adapts

It causes malabsorption in 2 out of 10 cases

Always a malabsorption (that's the goal, somewhere)


You check this noon the biological assessment of several of your patients, including that of Mr Ren, Kylo, 65 years old, known by the service for his chronic renal failure at 19mL / min. You then explain to your outpatient that kidney failure is often chronic, when we have arguments for its chronicity such as small kidneys, hypocalcemia and anemia. But the latter tells you that each time in MCQ he is asked for exceptions and that he can never remember them... Can you help?

Chronic renal failure on Sarcoidosis with hypercalcaemia

True, chronic pathologies leading to excess calcium, classically myeloma and sarcoidosis lead to chronic renal failure with hypercalcemia

Chronic renal failure on myeloma with polycythemia

False, there is no polycythemia in myeloma but anemia

Chronic renal failure with increased size of kidneys or kidneys of normal size, on diabetes

True, just like hydronephrosis, autosomal dominant polycystic kidney disease, amyloidosis or HIV-related nephropathy, diabetes does not cause a decrease in kidney size.

Chronic renal failure with increased size of the kidneys or kidneys of normal size, on chronic vesicoureteral reflux

False, it does not cause an increase in kidney size

Acute renal failure with hypocalcaemia on tumor lysis syndrome

True, but generally the context with the history of serum creatinine makes that we will be less wrong ;)


What is the biological sign(s) of functional acute renal failure?

Decrease in plasma urea in favor of plasma serum creatinine

False, in the context of functional acute renal failure, one literally has a drying of the body. As a result, we "no longer urinate" because we have "not enough water". Thus the concentrations of urea and serum creatinine will increase because we have more water.

>10 urinary urea concentration compared to plasma urea

True, simply because the urine that continues to be manufactured, no longer has all the components. In the urine, we have creatinine, urea, sodium and water to dilute all this among others. If we have more water in the urine, it is because the little we have left, we leave it in the blood to avoid complete dehydration. So more water in the urine, we have a concentration of urea in the urine very intense, more intense than in the blood (or there is still a little water)

<30 concentration of creatinineuria versus serum creatinine

True, you know as well as me, that extracellular hydration is governed by salt, so if we dehydrate, in fact we lose a lot of salt, which carries water with it. Therefore, we will avoid pissing the salt, to reabsorb the water! CQFD!

True, to reabsorb salt, the hormone that makes it possible to do this, is aldosterone!


You are an emergency intern in the emergency department of Ouessant (we can dream a little), and you receive Mr. Jones, Indiana, 39 years old, who back from Peru, did not hydrate well on the plane and has a picture of renal colic with a fever at 39 ° C.  You are looking to do an imaging and you have all the latest devices at home! What do you do?

Couple Abdomen without preparation and Renal ultrasound

False, because here we are in the context of a complicated renal colic (febrile) and in this case there is only one examination to do, cf. C.

False, uro CT is never done in the context of renal colic

True, this is the reference examination in front of complicated renal colic

If you receive his partner Marion Ravenwood, pregnant with 8SA, for the same symptoms, you would only have one imaging choice.

True, namely ultrasound! The rest is irradiating and therefore toxic to the fetus


Regarding the urological treatments of stones what are the exact proposal(s)?

Extracorporeal lithotripsy is contraindicated in case of aortic or renal arterial aneurysm

True, these are wave pulses, so imagine in case of anticoagulant treatment, fetus or arterial aneurysm, the destructive potential that it can have...

Ureteroscopy is the treatment of choice in a patient on antiaggregant or anticoagulant

True, because it is the only one that theoretically does not cause tissue damage

In case of obstructive pyelonephritis, urological treatment takes precedence over antibiotic treatment

Wrong, we are not going to operate in infected urine!

Extracorporeal lithotripsy is not very effective in obese patients

True, because shock waves have a harder time passing

Percutaneous nephrolithotomy is the most common treatment performed today.

False, it is clearly a second-line treatment


DHA (vasopressin) is produced by the hypothalamus

DHA (vasopressin) is produced by the pituitary gland

DHA (vasopressin) is released from the anterior pituitary gland

Diabetes insipidus is central if there is a defect in DHA production


You are in the emergency room and you receive Mr. XU Shang-Chi, 23 years old, for an attempt at drug autolysis with benzodiazepines. While he "slept" well until now he wakes up restless and sweaty and asks you for "something to calm him". In this context, you tell yourself that using a placebo is not a bad idea... But the nurse who is with you, fears a nocebo effect. You scratch your head and try to remember your pharmacology classes on the subject...

If you give the patient PARACETAMOL instead of a benzodiazepine, you are giving an impure placebo.

True, an impure placebo is a placebo that is composed of another active substance.

The placebo effect will have to be re-evaluated over time because it is short and runs out over time.

True, it is very logical because it is related to taking the treatment

Factors that condition the placebo effect include the name of the treatment

False, it includes color, shape, taste but not name

Chest pain, paresthesias and dysgeusia are the most common nocebos effects

False, nasty trap, but if you have understood that it is the administration of the treatment that makes the placebo you will have to logically deduce that the nocebos effects, also related to the taking of the treatment are mainly diarrhea, but also headache and drowsiness.

The nocebos effects are due to the composition of the placebo

False, it is related to the administration of the treatment


What are the different forms of rosacea?


False, topical corticosteroids are contraindicated in rosacea because they aggravate it!!

True, for more diffuse forms and especially ocular


What localizations are classically affected in seborrheic dermatitis?


How many cataract operations per year in France?


What type of cataract can occur as leukocoria?

True, leukocoria is the fact of having the white pupil, and it must worry, especially in the new nose in which it must suspect rare eye tumors


What is the form of cataract that is accompanied by index myopia?

True, involvement of the crystalline nucleus, predominance of a decrease in visual acuity (BAV) by far so index myopia

Saucer opacification in front of the posterior capsule, identical discomfort from far and near. Thinking about the metabolic and iatrogenic origin


Among the following proposals concerning the assessment to be carried out pre-operative of a cataract, which are true?

Mode A ultrasound eliminates retinal detachment

It is the ultrasound in mode B that allows this. See this ultrasound image in mode B: https://www.realites-ophtalmologiques.com/wp-content/uploads/sites/4/2017/02/article-du-27_02-702x336.jpg

Optical biometry is done by ultrasound in mode A

Ultrasound mode A = axial ultrasound biometrics. Used to calculate the size of the implant.
The most recent technique of ophthalmic biometry is axial ultrasound biometrics. Ultra-difficult question but the college makes the difference.

OCT is only useful for retinal conditions

Keratometry measures the refractive power of the cornea

The normal refractive power of the lens is about 20 diopters


Which of the following propositions concerning the mechanisms involved in hypoxemia are true?

The shunt effect is the most common mechanism of hypoxemia.

Obesite-hypoventilation syndrome may be a cause of alveolar hypoventilation

The higher you go, the lower the O2 inspired pressure would be.

A shunt effect corresponds to the presence of well-infused but poorly ventilated lung areas.

A cause of alveolo-capillary diffusion disorder is pulmonary fibrosis

True: diffusion depends on the thickness of the different tissues separating the alveolar air from the capillary blood, and fibrosis increases this thickness


Which of the following propositions regarding post-traumatic rhabdomyolysis are true?

It is linked to the destruction of a large number of myocytes and the release of elements of these myocytes into the circulation.

True! Post-traumatic rhabdomyolysis is, as its name suggests, linked to the destruction of a large number of myocytes in the direct consequences of trauma to the limbs or its complications (compartment syndrome in particular)

The hydroelectric disturbances observed are hyperkalemia, hyperphosphoremia, hypocalcemia

True! Rhabdomyolysis is the bursting of muscle cells. So all the content passes into the blood and we can measure this content via a blood test:
- Increased K+ and phosphorus
- Decrease of Ca++ by transfer from the vascular medium to the muscular environment
- Increased muscle enzymes: CPK, LDH, myoglobin, AST +++, ALT +/-

Acute renal failure complicates about 50% of cases and determines the vital and functional prognosis

Acute renal failure due to post-traumatic rhabdomyolysis is responsible for a sodium ejection fraction < 1% (functional)

True! There are different causes of rhabdomyolysis. Generally we oppose:
- Post-traumatic rhabdomyolysis: Which is mainly related to the destruction of myocytes but also favored by HYPOVOLEMIA !! This explains why the observed ARI GENERALLY has a FeNa+ < 1% (functional)! It is the elderly subject who fell and did not manage to get up for 12 hours: he crushed his myocytes on the ground and did not drink. - Infectious/toxic rhabdomyolysis/by electrification/by taking lipid-lowering agents... etc.: Is related to the destruction of myocytes but here the volume is normal. The observed IRA will therefore have a FeNa + > 1% (organic)

The treatment is based primarily on crystalloid filling

True! Treatment is symptomatic above all (filling, hydroelectric rebalancing, extra-renal purification if indicated). SOURCE: College of Anesthesia Resuscitation 2020 Edition page 346


What clinical signs are found in spondylodiscitis?

False, inflammatory rachialgia, tenacious, without triggering factor and poorly calmed by rest (the suffix "-ite" means inflammation)

False, no effusion in spondylodiscitis, rather in peripheral septic arthritis

True, these are complications of inflammatory spinal pain


What is the reference imaging test in the diagnosis of spondylodiscitis?

False, radio-signs shifted by 3-4 weeks, they are often normal at diagnosis

False, indicated only to guide a puncture-biopsy or if contraindication of MRI

False, lower specificity than MRI. Used if contraindicated to MRI


Syringomyelic syndrome reflects the involvement of spinothalamic fibers that decuss at the level of each metamer

True, they are more sensitive to compression by fluid inside the spinal cord

The initial sensory deficit relates to proprioception

On thermo-algic sensitivity (first involvement of spinothalamic / extra-lemniscale fibers)

Arnold-Chiari malformation is the main cause of synringomyelia

The topography of the lesion syndrome is said to be "cape"

True, cause of upper limb deficit without lower limb deficit (excluding sublesional syndrome)


Which of the following propositions about Willebrand disease are true?

There may be a decrease in factor VIII in Willebrand disease

True because von Willebrand factor transports and stabilizes factor VIII

Willebrand disease is defined by a von Willebrand factor level < 50%

False, by a von Willebrand factor rate < 30%

Willebrand disease is a pathology of coagulation

False, it is a pathology of primary hemostasis

Von Willebrand factor allows platelets to adhere to each other and to collagen under endothelial


Which of the following propositions about hemophilia are true?

The hemostasis assessment finds a prolongation of the TCA and a decrease of the TP

False, only an isolated prolongation of the TCA because only the endogenous pathway is affected

Hemophilia is the most common inherited bleeding disorder

Drugs depressing hemostasis are contraindicated in hemophiliacs

Arthropathy can be a complication of hemophilia

True, it is a hemophilic arthropathy secondary to the aggression of cartilage by blood waste and their degradation


Regarding hypovitaminosis K, what are the true propositions?

Factor V is a vitamin K-dependent factor

False, vitamin K-independent; it is the X, IX, VII, and II (we can retain the year 1972) which are vitamin-K dependent

The majority of vitamin K intake is endogenous via the intestinal flora

False, the majority of vitamin K intake is exogenous via diet (70% intake)

One of the differential diagnoses is hepatocellular insufficiency

True, the 2 diagnoses are differentiated by the determination of factor V, vitamin K-independent

The TCA is lengthened and the PT is decreased at hemostasis

C- and S-clotting proteins are vitamin K-independent


Regarding the assessment to be carried out in case of fever during drug agranulocytosis, what are the true proposals?

It may include stool farming depending on the orientation


You are an intern and your intern has asked you to present a slideshow on the topic of myeloma. By having you recite it asks you what are the clinical forms of myeloma besides symptomatic multiple myeloma. You hesitate, and mentally try to summarize each clinical form in one sentence. Which of the following are the exact proposals?

Indolent multiple myeloma has no clinical involvement and only biological abnormalities

True, as its name suggests, indolent myeloma has no active clinical form, however it has a poor prognosis because it is at risk of progression to multiple myeloma

A solitary plasmacytoma will be associated with a negative myelogram

True, a plasmacytoma is by definition a tumor isolated (like a sarcoma) in a tissue, and therefore without invasion of the spinal cord.

Mild chain multiple myeloma causes monoclonal peak at serum protein electrophoresis

False, light chain myeloma does NOT cause monoclonal spike on serum protein electrophoresis

POEMS syndrome corresponds to a monoclonal gammopathy associated with bone lyses at the punch

Wrong, I admit this question is hard, because most of you will never have heard of POEMS: it is a form of myeloma with osteocondensation associated with splenomegaly, neuropathy and endocrine damage. It is rank C.

Waldenström's disease is a form of myeloma with osteocondensing lyses

False, Waldenström's disease is the MAIN differential diagnosis of myeloma


What is the percentage survival of patients with lung cancer treated at stage I, at 5 years?


What is the survival of patients with lung cancer treated at the metastatic stage (V), at 5 years, in percentage?


True because the molecule does not pass the outer membrane

Penems are useless on Pseudomonas aeruginosa

Only ertapeneme that does not work on enterococci and on Pseudomonas


What is the weekly malaria chemoprophylaxis?


Which of the following proposals for protective measures against Anopheles bites is recommended?

Use of household repellents and insecticides


Against which germs is the hexavalent vaccine, administered in children under 1 year of age at M2 M4 and M11?

It does not fit into the hexavalent (it is all alone)


A patient wants to go to Cameroon for 6 months. What vaccination(s) do you prescribe?


What situations are at risk of invasive pneumococcal disease, and therefore constitute an indication for preventive vaccination against pneumococcus?


For which stays is the yellow fever vaccine mandatory?

Tetravalent meningococcal vaccine ACYW135 conjugate


What is the probability of death during a tropical trip?


What propositions are true about typhoid fever?

The vaccine is in one dose, valid for life

True for yellow fever. The salmonella vaccine is not very effective, and must be redone every 3 years


How many dose(s) for yellow fever vaccine?


Vaccination protects in 100% of cases from the occurrence of salmonellosis

60% effectiveness, than against certain strains

vaccination must be renewed every ten years

vaccination does not protect against Salmonella enterica serotypes of Salmonella enterica paratyphi A and B

Vaccination is mandatory for healthcare workers

microbiology laboratory personnel in contact with stool

Vaccination for typhoid is possible from the age of two


What pathologies do ticks have as a vector?

True, as the name suggests. No trap here


What pathologies do Aedes have as a vector?


In what situations can joint fluid be inflammatory?

True, we also find in the joint fluid micro-crystals (urate, PPCa, Ca phosphate ...)

True. The causes of inflammatory fluid (i.e. with more than 2000 cells per mL) are: septic arthritis, gout, chondrocalcinosis, RA, spondyloarthritis, ... Causes of mechanical fluid: osteoarthritis and meniscus injury


Which of the following can be part of the pre-therapeutic assessment prior to the initiation of targeted therapy?

True, for anti-IL6 and anti-JAK treatment


From what score can we speak of densitometric osteoporosis in adults?

False, the Z score is used in children who have not reached the peak of bone mass.


Which of the following fractures are severe?

Fracture of the upper extremity of the humerus

True. The complete list: vertebral, pelvis / pelvis / sacrum, upper end of humerus, upper end of femur


Which osteoporosis treatments are osteotrainers? (one or more correct answers)

False, it is a selective estrogen receptor modulator (SERM), which slows bone resorption. Contraindicated after 70 years. Not active on peripheral bones

False, it is an anti-osteoclastic treatment, slowing bone resorption

False, it is a treatment that slows bone resorption

False, it is an anti-RANK-L antibody (biotherapy), which slows bone resorption

True, it is a recombinant fragment of PTH, which stimulates bone formation. Trade name = Forsteo. One subcutaneous injection every day at the same time for 18 months


What biological arguments are in favor of osteomalacia?

False, we will rather have hypocalciuria. According to the college: Osteomalacia is a diffuse, rarefizing, weakening osteopathy of bone tissue characterized histologically by a significant delay in mineralization of the newly formed organic matrix, which leads to an accumulation of osteoid tissue. The biological arguments are: a decrease in serum calcium and phosphatemia; an increase in alkaline phosphatase; a collapse of 25(OH)-vitamin D (reserve form) < 5 ng/ml; hypocalciuria and hyperparathyroidism secondary to hypocalcaemia.


What elements are in favor of an inflammatory joint fluid?

Presence of calcium pyrophosphate crystals

True, on direct examination or after cultivation


A DAS28 to 3.0 score defines rheumatoid arthritis:

True, low activity 👉 level 2.6 < DAS28 < 3.2

False, moderately active 👉 3.2 < DAS28 < 5.1


Which of the following are possible extra-articular manifestations of RA?

True, hence a systematic chest X-ray to discover RA

False, osteoarticular manifestation of RA


What can be the extra-articular disorders of spondyloarthritis?

False, joint involvement of the coxofemoral joint

False, pain reflecting joint involvement of the sacroiliac


True, radio-transparent lithiasis with uric acid (represents 10% of urolithiasis)

False, hallux dactylitis should not be confused with gouty attacks of MTP1. Dactylitis is found in spondyloarthritis for example


What elements can be found when diagnosing complex regional pain syndrome (CRPS)?

False, mechanical fluid, with less than 2000 elements (other causes: osteoarthritis, meniscalgia)

False, normal CRP, no biological abnormalities in CRPS

Hyperfixation to the 3 stages of scintigraphy

False, may be normal but sometimes presence of edema especially osteomedullary


Which tumors can classically give paraneoplastic syndromes responsible for autoimmune encephalitis?

True. These are CBPC, testicular and ovarian cancers, and hemopathies and related diseases (thymoma)


What are the 2 most common germs found in meningitis in children under 2 months of age?

True, by contamination by proximity to the digestive tract during childbirth most often

True, also called group B beta-hemolytic streptococcus (SBHB), hence the importance of systematically looking for it before delivery via a vaginal swab

False, it is rather in the child over 2 years old unvaccinated

False, it is rather in children between 1 and 2 years, then in adults over 25 years


You are a country doctor in a very under-endowed area thanks to your CEPA, and you are called for Monique, a farmer, 48 years old, who has been feverish since this morning, and has small crimson spots, all black, hollow, trunk multiplying at high speed. His cat, who is a fine semiologist, has noticed that they do not fade when he presses on them to chase them away. Her husband is warming up the engine of the 308 a little tired to transport it to the emergency room when you arrive aboard your brand new 🛵 Vespa. What are the real propositions?

It is a vital emergency, her husband cannot transport her, medical transport is needed

True, it is a purpura fulminans 👉 we inject the C3G that is in our emergency bag and we call the 15

It is a legal obligation for any liberal doctor to have on him enough to perform an IM injection of C3G in this type of situation

True, even ophthalmologists and psychiatrists!

If you don't have C3G, you can inject amoxicillin IM

True, it's not as good, but it's much better than nothing.

You call the multi-purpose medicine at the nearest clinic to hospitalize the patient as soon as possible

False, this patient must be hospitalized urgently in intensive care or intensive care

You need to put on an FFP2 mask to protect yourself

False, it is an isolation droplets, a surgical mask will be enough


Which of these CSF biochemistries are normal?

Rock water, 0 element, glycorachia at 0.9 x glycemia, 0.20g/L proteinorachia, 0.25mM lactates

True, standards are
a) < 5 figurative elements (without PNN or red blood cells, with 60% lymphocytes and 40% monocytes),
b) glycorachia greater than 2/3 x blood glucose
c) a proteinorachia of less than 0.40 g / L
(d) a lactatorachia less than 3.2 mM

Rock water, 4 elements (1 red blood cell, 3 monocytes), glycorachia at 0.7 x glycemia, 0.5g/L proteinorachia, 0.25mM lactates

False, the presence of red blood cells can make suspect a traumatic PL (bad external bouuuh! [this is not true]). In addition, we have a little too much protein

Cloud, 500 elements (majority of PNN), glycorachia at 0.2 x glycemia, 1.50g/L proteinorachy, 5.43mM lactates

False, and it is even very suggestive of purulent meningitis (in view of PNN, glycorachia, significant proteinorachia and lactates)

Rock water, 500 elements (mostly lymphocytes and monocytes), glycorachia at 0.5 x glycemia, 1.20g/L proteinorachia, 3.2mM lactates

False, and it's quite suggestive of lymphocytic meningitis

Rock water, 4 elements (2 lymphocytes, 2 monocytes), glycorachia at 0.7 x glycemia, 0.35g/L proteinorachia, 3.0mM lactates


What are the two infectious agents that cause rhombencephalitis?

True, children who have chickenpox often walk not straight! It's benign and it regresses alone most often

True: in front of a pregnant woman who does not walk straight, before fetal alcohol syndrome, look for listeriosis!


Which of these patients need a check-up before their lumbar puncture? Which exam is it?

An 18-year-old woman, with no history, with normal clinical and neurological examination other than stiff neck, photophonophobia, and fever

No, it can be assumed that she has a TP > 50%, a TCA < 1.5, and platelets greater than 50G/L since she has no particular history

True, it must be made sure that it has a TP > 50%, a TCA < 1.5, and platelets greater than 50G / L

A 3-month-old child with clonic movements of the right hand since this morning associated with high fever and photophonophobia

False, he has a typical picture of meningitis and, before 5 years, the only signs of localization that should have an MRI performed are hemicorporal crises

A 35-year-old adult with clonic movements of the right hand since this morning associated with stiff neck and fever

True, in humans over 5 years of age, any sign of localization must have a cMRI performed before PL to avoid engagement

A 4-year-old child with twitching of the upper and lower right limbs associated with a sunset gaze

True, it has a sign of localization (clonies of the right hemibody). He also has a sign of HTIC, which must also have an imaging assessment done before the PL


In which cases should a first dose of antibiotic therapy be given before PL in front of a meningitis chart?

Hospital care impossible in less than 60 minutes

True, it sucks, we are close to the cata, we go into cowboy mode (we do hemocs quickly done before anyway)

Known and uncorrectable hemostasis abnormality

True, you need a PT, a TCA, and normal platelets before going

Isolated rapidly worsening alertness disorders

False! Not as long as they are isolated (so not associated with hemodynamic disorders)

True! Always do antibiotics before imaging. Indications for brain imaging:
-signs of HTIC
-hemicorporeal seizures before 5 years
-focal or generalised seizures after 5 years / signs of localization


What elements are part of encephalitic syndrome?

True, these are globally the contraindications relating to PL in front of meningoencephalitis: signs of localization, vigilance disorders (rarely isolated), delirium syndrome, epileptic seizures (most often partial), neurovegetative disorders

Distractor, photophonophobia is in meningeal syndrome


Regarding precautions for meningococcal meningitis:

Caregivers should wear FFP2 before the first dose of antibiotic

Caregivers must wear a surgical mask for up to 24 hours after the first dose of antibiotic. We are on an additional droplet protection

Caregivers should wear FFP2 for up to 24 hours after the first dose of antibiotic

Caregivers should wear FFP2 for up to 48 hours after the first dose of antibiotic

Antibiotic prophylaxis should be available to caregivers who have practiced mouth-to-mouth and those who have spent at least one hour with the patient without a mask

Caregivers must wear a surgical mask until the first dose of antibiotic


In front of a typical picture of pure encephalitis without associated meningitis in pregnant women, probabilistic treatment will include:

We are not trying to cover the CVMP:) It is HSV that gives encephalitis

True, to cover listeria because she is pregnant; If it wasn't, it would be debatable.

We do not try to cover streptococcus or meningococcal in encephalitis

True, to cover HSV Let's go IV (and therefore not VALACICLOVIR)

False. Indeed, in the pilly 2021, the indications for corticosteroid therapy are very clear (and do not include HSV encephalitis): diagnosis of pneumococcal or meningococcal meningitis of adults or tuberculous meningoencephalitis. (This proposal was counted true by mistake until May 14, 2022, when an external reported the error, thanks to her!)


What statements are true about Listeria monocytogenes?


It is a bacillus with facultative intracellular development

It is able to multiply at low temperatures (4°C).

It has natural resistance to cephalosporins

Yes, this bata**🙄. But it can be beamed with amox (+genta, for good measure). Germs naturally resistant to C3G are LLEIA (as in Star Wars): Legionella, Listeria, Enterococci, Intracellular (-> macrolides) and Strict anaerobes (-> metronidazole)

It can colonize food and contaminate the cold chain


Immunosuppression worsens Listeria infection

True, at the same time it's pretty much always true, huh, "immunosuppression worsens..."

Mortality can reach 45% in Listeria septicaemia


How do you get contaminated with Listeria?

Cheeses made from raw milk except pressed pasta

Listeria does not alter the taste of food


Which of the following are sequelae of herpetic meningitis? (one or more true propositions)

True, it is most often secondary to a viral infection (reminder: hyperorality, hyperphagia, hypersexuality)

True, memory disorders in general, which can go as far as Korsakoff with anterograde amnesia and fantasies


Which tests concern the subspinatus and small round muscles? (one or more correct answers)


What tests can highlight an acromioclavicular conflict?


What tests concern the subscapularis muscle? (one or more true answers)


What tests concern the supraspinatus muscle? (one or more correct answers)


Regarding knee ligaments, which proposals are true?

It prevents internal rotation. Valgus is countered by the LLI


What are the complications of acromegaly to look for?

Secondary diabetes or glucose intolerance

It is multinodular goiters that are common


What are the etiologies of white scintigraphy with increased T4L?


What propositions are true about ARI therapy?

It allows the targeted destruction of thyroid residue

Thyroid residues are able to selectively capture iodine-131

Treatment is indicated in all patients who have undergone total thyroidectomy

Treatment is only indicated in patients who have undergone total thyroidectomy and are at high risk of recurrence


You explain to your patient the need for thyroid surgery (total thyroidectomy), and inform them of the potential complications of the procedure:

The phrenic nerve originates from C4 and innervates the diaphragm. Not to be confused with laryngeal nerves


From what size, in centimeters, is a thyroid nodule rather suspicious?


Who is the definitive host of Toxoplasma gondii?


What are the typical aspects of brain toxoplasmosis on MRI?


What are the possible clinical forms of toxoplasmosis in immunocompromised people?


What elements are part of the table of primary toxoplasmosis infection of the immunocompetent subject?


Regarding HIV testing in pregnant women:

The risk of transmission is 0.3% if the mother's viral load is undetectable

No damage to the fetus but possible contamination


In how many cases, in general, is the primary toxoplasmosis infection of the immunocompetent subject symptomatic?


What meningitis causes normoglycorachic CSF?


Anissa, 12, is on holiday in Corsica when she is hospitalized in intensive care for meningococcal meningitis. With regard to public health aspects, which proposals are true?

Her nanny, who looks after her 4 hours a day, and who last saw her 12 days ago, must benefit from antibiotic propylaxis.

His mother, who is allergic to quinolones which are the antibiotic of choice, may receive cefotaxime instead.

His father, who is allergic to quinolones and C3G, will receive the last line of antibiotic prophylaxis: rifampicin.

His brother, who is allergic to rifampicin which is the antibiotic prophylaxis of choice, may receive a single dose of C3G or quinolone.

True, antibiotic prophylaxis of meningococcal meningitis:
1) Applies to individuals who have spent more than one hour within one metre of the case in the 10 days prior to diagnosis
2) applies to caregivers who have practiced mouth-to-mouth, or have intubated/aspirated the patient without a surgical mask

and

3) consists of RIFAMPICIN 600mg x 2 per day for 2 days (or 10mg/kg per dose but not exceeding 600mg per dose) as a first line
4) may consist of CEFTRIAXONE 250mg IV single dose (125mg in children) or CIPROFLOXACIN 500mg PO single dose (20mg/kg in children)

Children in the household will be offered to vaccinate them, but not adults because catch-up only takes place until 25 years of age.


List: Japanese encephalitis
Tick-borne Encephalitis
West-Nile encephalitis
Dengue fever
Chikungunya
Zika
Yellow fever


What are the diseases with faecal-oral transmission?

Virus encapsulated and therefore fragile in the external environment (just like HCV and VHD)


What is the clinic of the typhoid fever invasion phase?

State phase: Plateau fever at 40°C, Tuphos, dig disorders, rash, Duguet's angina (ulcerations)


What are the infectious etiologies to evoke in case of diarrhea in return from tropical countries if the patient is apyeric?

Febrile diarrhea: Salmonellosis, Shigellosis, Campylobacter, Clostridium difficile, Viral hepatitis, Malaria, Primary HIV infection


West-Nile viral encephalitis / Japanese, bites at night

Borreliosis, Rickettsia, Tick-borne viral encephalitis


What are the two mandatory vaccinations for travellers that can be requested at customs when travelling to endemic areas?

True, in intertropical Africa and the Amazon

True, during a pilgrimage to Mecca (recommended otherwise)


What are the two leading tropical causes of fever after returning from a stay in the tropics?

Cause of diarrhea without fever during travel


What is the most common cause of non-febrile diarrhea when returning from a trip to tropical countries?

Diarrhea from primary HIV infection is febrile

True, test treatment with Metronidazole, diagnosis with EPS

Febrile arbovirus, no diarrhea classically


What are the infectious agents that can give acute encephalitis accompanied by single nucleosic syndromes?

HHV6 does give a mononucleosis syndrome but classically no encephalitis.


The mother of 8-month-old Josephine wants to take her on a pilgrimage to Mecca. What can you tell him about vaccination?

Her daughter may be offered a meningococcal C conjugate vaccine

Yes, absolutely. Mandatory vaccination for children born since January 1, 2018 is also mandatory, with a dose at the age of 5 months and a booster at the age of 1 year. Catching up until the age of 24 is possible.

Her daughter may be offered a polysaccharide vaccine against meningococci A and C

Yes, because the area it crosses also has a circulation of serotype A, and this from 6 months

Daughter may be offered a meningococcal B protein vaccine

False, only in immunocompromised patients (allogeneic HSCT, asplenia, properdin deficiency, terminal complement deficiency)


The value of creatinine in plasma is inversely related to the Glomerular Filtration Rate

The more kidney function increases, the more serum creatinine increases

Increased creatinine signs a deterioration in kidney function

The value of creatinine in plasma depends only on renal function

Creatinine is a perfect marker of kidney function

Very imperfect because dependent on muscle function, very variable from one individual to another

A value of 150 μmol/L is normal in women

Acceptable values: between 50 and 90 μmol/L in women and between 80 and 115 μmol/L in men


Regarding the estimation of creatinine clearance:

The formula of Cockcroft and Gault was established in antiquity

Renal physiology was still largely unknown until the Renaissance. Cockroft and Gault's formula was published in 1976.

The Cockcroft and Gault formula allows direct estimation of GFR

It is an estimate of creatinine clearance which is itself an estimate of GFR

The Cockcroft and Gault formula takes as a parameter the rate of muscle mass and the height of the patient

4 parameters of age, sex, weight and serum creatinine

The result obtained through the Cockcroft and Gault is not indexed to body surface area

The formula of Cockroft and Gault is recommended in the elderly

Poor performance in the elderly and obese subject


The MDRD and CKD-EPI formulas estimate a GFR that is indexed to body surface area

MDRD and CKD-EPI include weight, sex, age and serum creatinine

CKD-PPE is more recommended than MDRD for high serum creatinine values

This is the case for low values of creat

note that they cannot be used: in children (use Boyd's formula)

It should be noted that they can not be used: in children use Schwartz's formula!

Chapter 15): GFR is normal between 90 and 120 ml/min/1.73 m2; Between 60 to 89 ml/min/1.73 m2, chronic renal failure is mild


The Cockcroft formula takes into account:

True: serum creatinine, age, sex and weight


Mass cancer screening in France is justified if:

As a result, we would not have time to detect him that he would already be there

the cost of testing is considered acceptable by society

And more precisely, by the representatives of the company

The overall survival gain has been proven in France by serious studies

Not in France. Most often, these are international studies


You receive in general medical consultation, Mr BINDINGOF, Isaac, 83 years old, who has just moved into France, so this is the first time you see him in consultation. He presents you with a prescription "as long as the arm" including no less than 18 drugs. Among these are 5 anti-hypertensives, 3 analgesics, 4 psychotropic drugs, creams / ointments, a statin and so on! You break your head and decide to review this prescription a little... What do you do?

Check that the patient is taking his treatments and following non-drug measures

True, this is the MAIN measure to be carried out before prescribing "triple therapy for everything" as we often say in general medicine. In addition, the patient will not often spontaneously say that he does not take his treatments... It must be seen that a prescription with 18 drugs is an ordeal for the patient who will often take according to his moods! (Situation experienced during internship)

Spontaneous discontinuation of benzodiazepines due to low level of evidence in the elderly

False... Even if we do not like benzodiazepines too much (and rightly so!) for their risk of sedation, falling, in the elderly, we must not make a sudden stop! It is necessary to reduce the doses, space the doses, in short to make a long and tedious weaning but it must be done!

Check the dosages of treatments, to look for a minimum effective dosage

True, some drugs require dosage adjustment due to the physiological aging of the body. We will therefore think about evaluating kidney function with a small blood test well felt, and liver function also, even if it is more complicated.

Do not prescribe tablets in the face of the risk of false routes

False, even if often true in geriatrics or nursing homes, advanced age alone is not a contraindication to taking tablets! The risk of false routes and swallowing disorders must be assessed before

Check the MA of treatments to avoid off-label therapies

True, it is better to prescribe "safe" treatments in the elderly and not to try too much off-label or off-recommendations. In fact, at ECNs, it is always true that one should not prescribe off-label.


It is not necessary to remove or treat all modifiable risk factors

Aspirin and statins help reduce inflammation.

Statins reduce the accumulation of LDL but not stabilize plaques.

False, they are used to reduce the accumulation of LDL, stabilize plaques, regression of the volume of plaques.

Antihypertensive treatments reduce mechanical stress.

True, blood pressure puts mechanical stress on blood vessels

When rupture of plaque, antiplatelet and heparin drugs must be used, but not urgently.


What arguments are in favor of an arterial leg ulcer?

True, skin coloration depends on the oxygenation of the blood, therefore arterial blood

True, in obliterating PAD the limbs are cold because they are not vascularized (they are also very painful and hard, and there is no pulse, but we go astray)


What arguments are in favor of a venous leg ulcer?


It is used for the classification of aortic insufficiency.

Type I corresponds to mitral valves that remain in the same plane as the ring.

Type II corresponds to at least one valve exceeding the plane of the ring, the valve play is then decreased.

False, valve play is increased in type II.

Type IIIa corresponds to a valve set decreased in systole and diastole.

Type IIIb corresponds to a valvular set decreased in systole and diastole.

False, type IIIb = systolic restrictive.


Which of the following proposals about Horton's disease or giant cell arteritis is true?

Horton's disease affects the large vessels, including the carotid vessels, aorta and femoral vessels.

False, large vessels are represented by the carotids, aorta and iliac arteries.

Horton's disease headaches are temporal, beating, with hyperesthesia of the scalp

True, this is also called the comb sign (when patients paint themselves, it hurts, because of hyperesthesia)! To look for during the clinical examination

A decrease in visual acuity occurring during headache should suggest a CRAO

False! It's NOIAA! To better remember:
- OACR is an ischemic occlusion of the vessel responsible for the vascularization of the retina, the central artery of the retina, completely painless because the retina is not sensorily innervated,
-NAOA is an acute ischemia of the head of the optic nerve, by occlusion of the posterior ciliary artery which is also a terminal branch of the internal carotid artery. It is also painless. The BAV is always total ("blackout"), while the OACR can sometimes leave a very diminished vision.

Remember the NOIAA because it is the real emergency in Horton's disease (general corticosteroid +++)

Corticosteroid therapy is imperative after biopsy of the temporal artery, because the latter may be negativated by the treatment

False, even if corticosteroid therapy may negative the biopsy, in case of strong clinical suspicion, or clinical emergency, treatment should be initiated

The biopsy conventionally finds a giganto cell epitheloid granuloma without caseous necrosis with edematous panarteritis and rupture of the internal elastic limiting

True, to know by heart in detail, because this item falls ALL the time


What are the biological signs in favor of a PAS?

VDRL positive (contains phospholipids) and TPHA negative


Which of the following are the causes of polyclonal hypergammaglobulinemia?

True, proposition of rank C (the rest is rank A)

No hypergamma + autoantibodies (therefore monoclonal)


Which of the following tests are useful for suspected dermatomyositis?

True, allows you to look for cancer. About 20% of dermatomyositis are paraneoplastic

Antibodies for primary biliary cirrhosis


What are the clinical symptoms of allergic rhinitis?

PAREO symptoms:
-Itch
-Anosmia
-Rhinorrhea
- Sneezing
- Nasal obstruction
+ possible eye symptoms (conjunctivitis)


What are the infectious agents responsible for infective endocarditis?

False, second at 20% behind Staphylococcus aureus.

Enterococci and coagulase-negative Staphylococci equal (10%).

Blood cultures are negative in only 2% of cases.

False, in 5-10% of cases. It is necessary to specify "endocarditis research" on the request to the lab so that the culture is prolonged!


Among these pathologies, which belong to group A of infectious endocarditis said to be at high risk of infective endocarditis?

A history of 1st degree infective endocarditis.

False, NOT cyanogenic = NOT high risk (except atrial septal defect).


What are the extrahepatic complications of HCV?

This is one of the possible complications of HBV infection

HCV is not accompanied by extrahepatic involvement


What is the treatment to be systematically initiated in a child born to an HIV+ mother?


Which infectious pathologies are favored by the AIDS stage?

The full list: Pneumococcal pneumonia, influenza, STIs in general, HBV and HCV


For which germs is the addition of clavulanic acid useless?

True, because modification of the target (not a production of penicillinase)

Pneumococcus of decreased sensitivity to penicillins

Pyo never sensitive to either amox or augmentin so adding unnecessary clavulanic acid


Which bacteria are most sensitive to amoxicillin?

Susceptible to augmentin and cephalosporins


What are the modalities of vascular filling?

Colloids have no demonstrated efficacy in this indication but an increased risk of acute renal failure. We NEVER tick colloids at the ECN (they are almost no longer used in practice, except by people very specialized in very specialized indications)

True, in adults. In children, 20mL/kg is retained in the syringe.

True in adults. A filling (unlike hydration) is done in free flow on a track of good caliber. This makes about 500mL of solute pass in 15 minutes


How long is eviction in impetigo after starting treatment?


Neurology intern brilliantly received at ECN, you receive a 40-year-old patient with fibromyalgia, irritable bowel syndrome, and psychogenic non-epileptic seizures. She consults you for a heterogeneous table. It reports:
-severe pain in the territories C7 left, T10 bilateral, L3 right, S1 right;
-bilateral facial paralysis;
-a history of red ring that spread quickly following a walk in the forest in Alsace 6 months ago.
She is convinced she has Lyme disease. What do you propose to him?

In view of the field, it is very likely that his symptoms are part of a somatoform disorder, so you refer him to a specialized psychiatrist colleague and avoid multiplying unnecessary examinations because it increases the symptoms

False! It's a typical picture! Multiradicular involvement + bilateral FP in the aftermath of erythema migrans!
If we should not multiply the examinations in a patient with a somatoform disorder, most patients with this type of disorder also have poorly managed organic comorbidities, and rectifying these treatments reduces psychiatric symptoms!

You offer to perform a lumbar puncture, and you expect to come across normoglycorachic lymphocytic meningitis

You propose to perform a Lyme serology and a PCR on CSF + blood

True, that's how secondary phase diagnosis is made.

Neurological damage to Lyme is conventionally installed in the tertiary phase, it's too early


Regarding the treatment of bacterial meningitis:

Probabilistic treatment of meningitis depends on direct examination of the PL

If direct examination for PL is negative, dexamethasone + C3G + amoxicillin + gentamicin is most often offered

Ohla, the Sécu is good, but the selection of resistant germs, less! This is what is proposed in case of strong suspicion of listeriosis. For "simple" meningitis, we are satisfied with C3G + dexa, it covers pneumococcus and meningococcal

If direct examination of PL finds diplococci, regardless of their Gram, we will propose a C3G IV for 14 days and dexamethasone 4 days

It's almost true:
-Gram-negative diplococcus: meningococcal -> C3G IV 4-7d + dexa 4d
-Gram-positive diplococcus: pneumococcus -> C3G IV 10-14d + dexa 4d
And if you ever get it out (unlikely):
-gram-positive bacillus: listeria -> amoxicillin 21d + gentamicin 5d

In the presence of a C3G-resistant pneumococcus, potentiation with vancomycin

True, we speak of resistance when the MIC is greater than 0.5

The doses of C3G are: Cefotaxime 300mg/kg/day IVSE after a bolus of 50mg/kg over 1h, or in 4 IVL Ceftriaxone 100mg/kg/day in 2 IVL


What are the risk factors for impaired pneumococcus for penicillin (PSDP) in children?

Easier to be in contact with a resistant germ in community (in the same way, there are more MRSA in hospitals than in the Aveyron countryside [heart on it by the way])

Reinfection with treatment-resistant germs given at previous AOM

taking penicillin less than 3 months ago

Selection of the resistant strain that took a few months to reproduce and give the new otitis

taking fluoroquinolones less than 3 months ago


Which bacterial infections are not responsible for neutrophil polynucleosis?

Conventionally, bacterial infections are accompanied by a reaction of the innate immune system that recruits neutrophils to fight bacteria. However, in some cases (tuberculosis, brucellosis, syphilis, whooping cough or thyphoid fever infections), there is no polynucleosis but rather hyperlymphocytosis. This is an interesting feature to keep in mind, both for the NEC and for future clinical practice.


What are the national structures for the control of nosocomial infections?

It is he who implements the plan to fight against NI

The National Institute for Health Surveillance is a network for the Alert, Investigation and Surveillance of nosocomial infections

The Centre for Coordination and Control of NI is a regional network.

The Hospital Hygiene Operational Team acts, as its name suggests, at the local level

The ANSM's mission is not to fight against nosocomial infections.


At what age is the pertussis vaccine booster?

True, and then we reassess if the patient is in a cocooning (takes care of a child under 6 months)


Live vaccines contraindicated in immunosuppression

Live vaccines contraindicated in pregnancy


What is pneumococcal polysaccharide vaccine?


What does Caroli's triad contain, which corresponds to the pre-icteric phase of infection with a hepatotropic virus?


Loperamide, anti-diarrheal retarder, is contraindicated below:

True, it is also contraindicated in case of invasive diarrhea (dysenteric syndrome) because it decreases the elimination of the bacteria


Which specific vaccine should be recommended when travelling to Eastern European countries (especially Austria) and Asia?

Adventurous stays in Asia, Africa including North Africa, South America...

Precarious hygiene conditions in an endemic country


Regarding the nasogastric tube in case of occlusion:

The nasogastric tube most often suppresses nausea

The nasogastric tube most often suppresses vomiting

The nasogastric tube does not contraindicate oral hydration

Nasogastric tube contraindicates oral liquid feeding

The nasogastric tube does not contraindicate hydration or oral fluid feeding, but occlusion may contraindicate them depending on its severity

The nasogastric tube should always be placed if the patient pulls it off.

Not systematically: we must first understand the reason for the patient's reaction and reassess the benefit/risk ratio


Everything is explained here 👉 https://www.researchgate.net/figure/Croisement-entre-lAICA-gauche-fleche-rouge-et-le-paquet-acoustico-facial-fleche_fig3_281713908