Context: A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g/dL (MCV 78 µm3), GB 8 G/L, blisters 247 G/L. Creatinine is 110 µmol/L (estimated glomerular filtration rate of 65 ml/min/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney.

What are the elements (present or to be sought at the interrogation and clinical examination) that can evoke a malignant tumor of the kidney? (one or more correct answers)

Tobacco is indeed a risk factor for kidney (as well as bladder) cancer.

Long-term calcium channel blocker treatment

A family history of multiple endocrine neoplasia


Which exam(s) are you asking for as a first line?

Urinary cytology with pathological examination

Cytobacteriological examination of urine

Abdominopelvic CT scan with and without contrast injection


On the cut shown below, what are the true propositions?  (one or more correct answers)

This is an abdominal CT scan with injection

Structure number 1 is the inferior vena cava

The cut passes through the third duodenum

The number 2 corresponds to the inferior mesenteric artery


What are the real propositions? (one or more correct answers)

The patient must receive red blood cells

The patient must receive platelet pellets

In case of transfusion of red blood cells, you would prescribe O-negative pellets

A search result for irregular agglutinins less than 48 h old must be available

Since 2003, there has been no risk of transmission of infectious pathogens through red blood cell transfusion


The glomerular filtration rate must be recalculated

An obstacle on the contralateral kidney is likely

An ionogram should be prescribed on a urine sample


What are the exact proposals? (one or more correct answers)

His antihypertensive treatment must include an inhibitor of the renin-angiotensin system

The LDL cholesterol target to be achieved is 1.3 g/L

He must follow a diet containing no more than 1.5 g/kg of protein weight

It is necessary to advocate a diet low in fast sugars


The ALD file is completed by the patient and validated by the medical specialist

The attending physician must specify in the request the protocol of care envisaged including treatments, examinations and consultations

The care protocol must be validated by the medical officer of the Health Insurance

In case of coverage in ALD, remains the responsibility of the patient only the co-payment

The third-party payer is the part of the care paid by the insured whether or not he is registered in ALD


What is your interpretation of the electrocardiogram below?


To reduce edematous syndrome, what do you recommend at this stage? (one or more correct answers)

A thiazide diuretic (hydrochlorothiazide)

Blood ultrafiltration (start of hemodialysis)


What are the possible cause(s) in the context of the new biological abnormality observed?

This is a POSSIBLE (but rare) cause of hypercalcemia by tertiary hyperparathyroidism, one really needs to read the statements carefully and take them to the first degree. It should be remembered, however, that chronic renal failure is mainly a source of hypocalcaemia.


What additional examination(s) do you recommend to explore this biological anomaly?


Which proposals are correct? (one or more correct answers)

Metastatic cancer is a contraindication to dialysis

Haemodialysis confers survival advantage over peritoneal dialysis

The preparation of an arteriovenous fistula (AVF) is contraindicated given the prognosis

A tunneled central venous catheter may be placed to initiate hemodialysis

A transplant from a cadaveric donor must be discussed


In general, regarding living donors, what are the real proposals? (one or more correct answers)

Only people with a genetic link to the recipient can be donors

Transplantation can be done in incompatible ABO condition

HLA incompatibility between donor and recipient is a formal contraindication

The donor is remunerated on a basis proportional to the recipient's waiting time


Context: For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg / m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections.

What additional examination(s) do you prescribe in early pregnancy?

Cytobacteriological examination of urine


Regarding trisomy 21 screening in this case, what is (are) the exact proposal(s)?

Nuchal translucency measurement is performed on an axial section of the fetus

Combined first trimester screening takes into account gestational age

Integrated sequential screening of the second trimester is not possible due to Turner syndrome

The patient's age is taken into account for the calculation of the combined risk of the first trimester

Total hCG is considered for combined first trimester screening


The initiation of treatment with spiramycin is lawful

Amniocentesis should be offered at least 4 weeks after the expected date of seroconversion

Cross-reaction with other infectious agents may explain this serological result


You start treatment with spiramycin. Regarding this molecule and the pharmacological class to which it belongs, which is (are) the exact proposal(s)?  What is the exact proposal(s)? B. The genome of

Spiramycin has a parasiticidal action on Toxoplasma gondii

Spiramycin acts by inhibition of bacterial proteins by binding to a ribosomal subunit

Spiramycin is active on Mycoplasma hominis

The therapeutic class is used in the treatment of pertussis


You decide to look for mother-to-fetal transmission of T. gondii. What are the exact proposal(s)?

A search for specific IgG is performed on fetal blood

Chorioretinitis should be tested by fetal ultrasound

Anemia should be sought by measuring brain velocities in Doppler


You perform an amniocentesis. The same evening, the patient comes to see you for abdominal pain that has lasted for several hours. There is no vaginal discharge and no bleeding. The patient is apyretic and normotensive. The cervix is shortened to the vaginal touch and measures 18mm. What treatment(s) do you introduce?


After 24 hours of hospitalization, the patient notices losses of smelly fluid through the vagina. Uterine contractions have resumed and are painful. The temperature is 39.3°C.  She gets chills. Cardiotocographic recording shows fetal tachycardia and 5 uterine contractions every 10 minutes. What is the most likely diagnosis?

Most likely given the context (amniocentesis, fever).


In front of this chorioamnionitis and the presence of fetal heart rhythm abnormalities, you perform an emergency caesarean section under general anesthesia. As soon as the child is extracted, heavy bleeding of endouterine origin is observed. Manual delivery of the placenta is performed and the hysterotomy is sutured. The uterus remains soft and significant bleeding persists externalized vaginally despite the infusion of oxytocics. The patient is hemodynamically stable. What therapeutic option(s) can be used in this situation?


An infusion of sulprostone is initiated. One Hemocue reveals a hemoglobin level of 6 g/dL. Blood loss is estimated at 1500 ml. Blood pressure is 100/60 and heart rate is 130 beats per minute (bpm). A biological assessment is carried out. The anesthesiologist orders labile blood products in a life-threatening emergency. After 30 minutes, the bleeding seems to dry up and the results of the laboratory workup are available: Leukocytes 15.2 G/L. Platelets 70 G/L. Haemoglobin 5.7 g/dL. Prothrombin level 60%. Activated cephalin time 32/30. Fibrinogenemia 0.5 g/L. D-Dimers elevated. Which of the elements of this assessment is included in the definition of biological disseminated intravascular coagulation (DIC)?


Taking into account the biological assessment, a transfusion of a platelet concentrate and 4 red blood cells is performed as well as an injection of 1.5 g of fibrinogen. One hour after birth, the bleeding has now dried up. The patient is monitored for 3 hours in the recovery room before being transferred to intensive care. The caesarean section allowed the birth of a girl weighing 790 grams who was immediately supported by the neonatal team. The clinical examination at 5 minutes of life is as follows: respiratory rate 70 / minute, intercostal and suprasternal pull, intense xyphoidian funnel, moderate fluttering of the wings of the nose, expiratory whining with the stethoscope, paradoxical respiration, generalized cyanosis, hypotonia, oxygen requirements (02) at 50% to maintain a 90% saturometry. About the neonatal clinical condition, which is the exact proposal(s)?

The Apgar score is not interpretable in case of prematurity

This child's oxygen needs are a sign of severity

Generalized cyanosis is in favor of anemia of the newborn


The child's respiratory condition improves but after 36 hours in neonatology, his condition deteriorates sharply. A chest X-ray is performed. What diagnosis(s) can you retain from the interpretation of this shot?


You diagnose a right pneumothorax. After exsufflation of the latter, the respiratory condition of the child improves markedly. In addition, at 48 hours of the caesarean section, the mother complains of chest pain. In this patient, which pathology(s) should you eliminate first?


In addition to the chest doubt, the patient complains of dyspnea. Blood pressure is at 130/70 mmHg. The pulses are symmetrical. The temperature is 37.5 ° C.  You decide to immediately perform an emergency pulmonary angiography. What anomaly(s) do you identify on these 3 shots?


A pulmonary embolism is diagnosed. Heparin therapy at curative dose is introduced. The patient is transferred back to the maternity ward after 48 hours. She wants to breastfeed but worries because she has cold sores. What do you say about breastfeeding? (one or more correct answers)

Breastfeeding is possible despite heparin treatment

Breastfeeding is not possible, as the child is premature

Herpes labialis contraindicates breastfeeding

She won't have a milk rush due to Turner syndrome

Breastfeeding is not recommended in this patient due to complications of childbirth


Context: You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week.

For the evaluation of dependence, which of the following proposals, which corresponds to an instrumental function?


A dependent patient can benefit from the personalized autonomy allowance.  Select the right proposal(s) from the following:

It concerns patients over 60 years of age

It is assigned to GIR 5 and 6 according to the AGGIR grid

Its amount depends on the level of dependency

It also concerns patients in nursing homes


The IADL (Instrumental activities of daily living) scale is 6/8. The patient is not very informative, but she says she is tired as soon as she tries to make an effort. She comes accompanied by her daughter who finds her mother sad, and who mentions the progressive appearance of anterograde memory disorders, forcing her to note the information. She has trouble finding certain objects, or the names of her children that she sometimes confords, which saddens her. A month ago, she got lost in a neighborhood she knew well before, which worried her daughter and justified the consultation. The neurological examination is normal, without pyramidal syndrome or parkinsonism. The MMS is at 23/30, with a reminder of the 3 words at 2/3. Regarding the evaluation of recent memory in the neuropsychological assessment, the encoding is normal but the patient has a deficit of free recall well corrected by the indication (reactivity 87.5%). The Front Efficiency Fast Battery (BREF) is 15/18. You mention a major neurocognitive disorder according to DSM 5. Which of the following criterion(s) are actually part of it?

Decline in at least one cognitive domain

Interference of cognitive impairment with autonomy

Worsening of disorders during confusional episodes


Brain MRI shows Fazekas stage III vascular leukopathy, with two lacunar ischemic vascular sequelae, as well as Scheltens stage I hippocampal atrophy. The neuropsychological assessment shows a visuo-verbal impairment of subcortical profile, and a dyseexecutive syndrome. Which of the following diagnose(s) do you mention?


You are diagnosed with major neurocognitive disorder of cerebrovascular origin and depressive syndrome. Which of the following elements of processing are you starting at this stage?

The patient remains autonomous with an MMS score that does not seem to put her at risk.


The patient is sedentary, weighs 70 kgs for 1.52 m or a body mass index of 30 kg / m2. Blood pressure is 133/65 mmHg, heart rate is 45/min. Her daughter tells you that the patient always has a slow pulse when she takes her constants at home, between 40 and 50/min. The systolic pressure index is 1.2. HbA1C 7.9%, albumin 31 g/l, CRP 2 mg/L (normal 5), hemoglobin 12 g/dL. Regarding the cardiovascular risk factors of this patient, what measure(s) are you taking?


Regarding the systolic pressure index (SPI), which proposal(s) is(are) right?

It allows the screening of arterial disease obliterans of the lower limbs

Its measurement is contraindicated in case of critical ischemia

It is calculated as the ratio of ankle blood pressure to humeral blood pressure.

An SPI greater than 1.30 reflects incompressible, rigid and calcified arteries

It makes it possible to follow the evolution of arterial disease obliterating the lower limbs


The patient also reports three recent falls, while her daughter specifies that she did not fall before. The patient mentions a dizzying sensation during the first fall, fleeting, but evokes above all a clumsiness each time, as when she stumbled into the edge of a sidewalk. ENT explorations carried out in the city are normal. You perform a search for orthostatic hypotension. Choose the right proposal(s) from the following:

Negative research eliminates orthostatic hypotension

An acceleration of the heart rate > 100/min evokes dysautonomia

A decrease in systolic blood pressure 20 mmHg at orthostatism confirms the diagnosis

The absence of symptoms at orthostatism rules out the diagnosis

An isolated decrease in diastolic blood pressure of > 1O mmHg at orthostatism confirms the diagnosis


You confirm orthostatic hypotension in this patient. Which of the following factors, in the case of this patient, may have contributed to this?


The systolic pressure index is 1.2.What therapeutic measure(s) in first line do you take regarding this orthostatic hypotension?

Discontinuation of antihypertensive therapy


What abnormality(s) do you notice on this ECG?


In view of the entire file, what anomaly(s) are you looking for on the holter requested by the attending physician?


The holter shows sinus dysfunction (high-degree sinoatrial block) and nodal dysfunction (BAV2 Mobitz 2) with long periods of bradycardia between 35 and 40 per minute, without AF. Which treatment(s) do you decide?

Discontinuation of calcium channel blocker

-dipine is not bradycardial (non-cardio-selective).


Finally, tests show a creatinine clearance of 27 mL/min. You recover a value a year ago at 29 mL / min whose vascular and diabetic origin had been retained. What impact does this information have on your current or future treatment?

Contraindication to angiotensin-converting enzyme inhibitor therapy

Contraindication to bisphosphonate therapy if indicated

Contraindication to treatment with denosumab if indicated


Context: Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD.

This patient consumed 1 glass of whisky per day and 75 cl of wine per day. He has been weaned for 3 months following the discovery of cirrhosis. About cirrhosis, what is the exact proposal(s)?

Is a fibrous scar of the hepatic parenchyma


The clinical examination is unremarkable. He has no sign of portal hypertension, no sign of severe sepsis. The biological balance shows: Na at 135mmol / L, K at 3.7mmol / L, CRP at 15mg / L, creatinine at 80 μmol / L, urea at 6.1 mmol / L, Hb at 137g / L, platelets at 120G / L, PNN at 7.45G / L, TP at 43%, TCA at 35/28, AST at 69Ul / L, ALT at 33IU / L, Alkaline phosphatase at 146U / L,  gammaGT at 236 IU/L. The patient has abundant daily sputum. In front of dyspnea, you realize the arterial blood gases in ambient air: pH at 7.49, PCO2 at 29mmHg, P02 at 75mmHg, HCO3- at 22mmol. What is your interpretation (only one answer)?


Chest X-ray shows a left basal opacity. You complete by performing a chest scan. What is the real proposal(s)?

The mark A corresponds to the arch of the aorta

Benchmark B corresponds to the trunk of the pulmonary artery

The C mark corresponds to the left stem bronchus

Coordinate system D corresponds to the esophagus

The mark E corresponds to the inferior vena cava


The mediastinal window shows lymphadenopathy. Here is a chest window computed tomography section. What do you observe? (one or more correct answers)


What diagnostic hypothesis(s) can explain the entire thoracic clinico-radiological picture?


You suspect a tuberculosis miliary. How do you make the first-line diagnosis (one or more correct answers)?

Examination of sputum addressed in mycobacteriology for acid-alcohol-resistant bacilli (BAAR)

Cytobacteriological examination of urine addressed in mycobacteriology for acid-alcohol-resistant bacilli (RBBA)

Bronchoalveolar lavage addressed in mycobacteriology in search of acid-alcohol-resistant bacilli (BAAR)

Not in the first intention. It is done if the patient does not spit, the gastric tubing is negative, and the supiscion is diagnosis is strong.

Lymph node puncture by bronchial endoscopic ultrasound addressed in mycobacteriology in search of acid-alcohol-resistant bacilli (BAAR)

Transthoracic puncture guided by CT scan of the mass addressed in mycobacteriology in search of acid-alcohol-resistant bacilli (BAAR)


Sputum analysis shows 10 to 100 BAAR/field live. You retain the diagnosis of miliary tuberculosis to M. tuberculosis. Which examination(s) should be taken into consideration in your pre-therapeutic assessment?


What anti-TB treatment(s) will you offer this patient as a first-line treatment?


What is (are) the other measure(s) to put in place in this patient?

Request 100% coverage for long-term illness

Anonymous notification to the Regional Health Agency (ARS)

Anonymous notification to the Tuberculosis Centre (CLAT) of the department of the case of domicile


You start a combination of isoniazid, rifampicin and ethambutol. After 2 weeks, the patient leaves the hospital. You follow him every month in consultation, but you have doubts about the patient's compliance with the treatment. How do you monitor its observance? (one or more correct answers)


The patient wonders about the role of his profession in the occurrence of tuberculosis. You consult the table of occupational diseases 40b of the general scheme. This table indicates that (one or more correct answers):

Your patient's condition is in the list of conditions that can be recognized as an occupational disease

The period of care indicates that the patient must have been exposed for more than 6 months to be recognized as an occupational disease

Your patient's profession is in the exhaustive list of works

The patient can be directly recognized as an occupational disease

The application for recognition as an occupational disease must go before the regional committee for the recognition of occupational diseases


The patient asks you what advantage he can benefit from in case of a possible recognition as an occupational disease? (one or more correct answers)

Compensation for damage to possible secondary family cases

A pension based on last salary and disability rate


What is your interpretation of these pulmonary function tests (one or more correct answers)?


The chest computed tomography no longer finds the abnormalities previously described and the pulmonary parenchyma appears normal. On the other hand, there is abnormal dilation of the pulmonary arteries. You suspect pulmonary hypertension associated with portal hypertension. In which group of the International Clinical Classification of Pulmonary Hypertension will you classify this patient?


Context: An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g/L (8 mmol/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months.

On the wrist x-rays performed in the emergency room, what is(are) the exact proposal(s)?

There is an excess length of the radius compared to the ulna

The fracture of the radius has a metaphyseal site


On clinical examination, what element(s) do you find if the radius fracture is uncomplicated?

A hypoesthesia of the pulp of the first 3 fingers

An elective pain of the anatomical snuffbox


During the initial clinical examination, the patient fails to perform active flexion of the interphalangienoe joint of the thumb. What is the exact proposal(s)?

This may be due to compression of the median nerve in the wrist.

This must evoke a cause other than the fracture itself.

This may be due to paralysis of the long abductor of the thumb.

This may be due to paralysis of the opponent of the thumb

This may be due to damage to the tendon of the long flexor of the thumb.


Which imaging examination(s) prescribed in first line seem to you relevant for his functional impotence of the lower right limb?

Computed tomography of the pelvis and right hip

Angiocomputed tomography of the pelvis and right lower limb


In view of the X-ray of the pelvis attached, what is the exact proposal?

This is a type 1 fracture according to Garden's classification

This is a type 2 fracture according to Garden's classification

This is a type 3 fracture according to Garden's classification

This is a type 4 fracture according to Garden's classification

Garden's classification does not apply for this type of fracture


In view of the attached radiography of the pelvis, what is (are) the exact proposal(s)?

The angle between the head and the diaphysis is well reduced.

There are gaps in << the >> punch of the left iliac wing

It is a fracture of the trochanterian massif

There is a loss of congruence of the right coxofemoral joint


You explain to the patient that she has a fracture of the proximal femur that requires surgery. The patient is reluctant to have an intervention for fear of possible complications. Which proposal(s) is (are) accurate?

In the absence of intervention, fracture consolidation is possible

In the absence of intervention, there is a major risk of death related to complications of decubitus

The intervention is necessary to allow a rapid verticalization of the patient

The increase in the time before the intervention modifies the morbidity and mortality in the aftermath of the intervention

Stabilization surgery can effectively fight pain


Regarding anesthesia, what can you say to this patient? (one or more correct answers)

The choice between general or locoregional anaesthesia has no real influence on postoperative morbidity and mortality

It will be mandatory to place a venous catheter and that the patient remains fasting whether it is a general or locoregional anesthesia

There is no cardiac risk under regional anaesthesia

If the anaesthetist opts for regional anesthesia, the patient is not required to stay in the recovery room

Several analgesics are usually used multimodally to reduce morphine consumption postoperatively.


Prior to her fall, the patient was travelling to the home without technical assistance. For the past few months, she had been using a cane for walks and when she went shopping, she used a rollator. What is the exact proposal(s)?

Parker's mobility score takes into account walking outside the home

Parker's mobility score is a quality of life score

Parker's mobility score ranges from O to 9

Parker mobility score takes into account the location of the fracture line

After a fracture of the upper extremity of the femur, recovery of the anterior Parker mobility score is the rule


Which of the following leads to delay the surgical management of the patient?

A cutaneous opening next to the ulnar styloid


In this patient, you opted for proximal femur osteosynthesis using intramedullary material. Following such an intervention, what is (are) the exact proposal(s)?

There is a significant risk of dislocation

The risk of infection at the surgical site is low

The primary complication is the vicious callus.

If after one month, the fracture is not consolidated, it is a delay in consolidation

If after 8 months the fracture is not consolidated, it is pseudarthrosis


Days after osteosynthesis, the patient slips on the wet floor on her way to the toilet and falls again. The patient complains of increased pain in the right hip. You take x-rays of the pelvis and right hip. What is the exact proposal(s)?

There is a secondary displacement compared to intraoperative reduction plates

There is a high risk of osteonecrosis of the femoral head

There is a decrease in the effectiveness of action of ilio-psoas


During her fall, the patient also complains of spinal pain that you locate mainly at the thoracolumbar junction and which is accompanied by more diffuse pain. An MRI is performed. There is no transitional anomaly. In view of this review, what is the exact proposal(s)?

There is a deformation of the vertebral body of T12

There are signs of disc degeneration between L 1 and L2


The patient is reoperated on the right hip. In the aftermath of the intervention, she presents a state of agitation. Which element(s) of the clinical examination do you think is important in the etiological search for this state of agitation?

A measurement of capillary blood glucose


Context: A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it "hot". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%.

Which of the following is(are) one or more criteria for severity of acute bronchiolitis in this child?

The criteria are very specific. Temperature is not one of them.


In this child, which is (are) the essential examination(s)

Careful! The new HAS 2019 recommendation taken up in the R2C colleges of pediatrics make this proposal obsolete.


In front of this chest X-ray, what is(are) the exact answer(s)?

Presence of mean lobar alveolar condensation

Medium lobe because erases the edges of the heart


The child is hospitalized for 4 rounds for the treatment of bronchiolitis complicated by pneumornediastin. It was fed the first two days by nasogastric tube. Infusion was not necessary. His respiratory signs are improving. While he was out, he presents vomiting followed twelve hours later by profuse diarrhea with a temperature of 37.3 ° C.  What is the possible cause(s) of this acute diarrhoea?

He didn't get antibiotics. He is not feverish.


Regarding the episode of acute gastroenteritis of viral origin, which is(are) the exact statement(s)?

It is an infection preventable by droplet precautions << >>

The germ responsible for diarrhea is resistant to hydroalcoholic fluids (SHA)

It is necessary to make a declaration to the ARS (Regional Health Agency) of this infection


Given the severity of the picture, intravenous rehydration is decided. A blood sample is taken at the time of the infusion. The results of this assessment are as follows: natremia 125 mmol / L, serum potassium 3.7 mmol / l, blood glucose 7.4 mmol / L. What is (are) the possible diagnosis(s) in this child?

Oral rehydration with pure water given by parents

Intravenous rehydration with a solution not rich enough in sodium


At the end of the infusion, the child makes clonic movements of the 4 limbs for 1 minute. It has no post-critical deficit. Which of the following diagnoses can be considered in this child?

An occasional seizure related to hyponatremia


After a few days, his clinical condition has improved and you prepare the discharge, he weighs 6000g and by taking the health record you find that he has not been followed since his arrival in France and that no vaccination has been carried out. You worry about his psychomotor development. What are the expected acquisitions for his age?


Given the vaccine delay and its age, which of the following vaccines, is the one to be prioritized?


Before the outing, which of the following dietary tips do you give to parents?

In case of family history of allergy, the introduction of peanut should be postponed

Cow's milk can replace infant milk from the age of 1 year

It will be necessary to give 5 fruits and vegetables per day 1 month after the beginning of diversification


You see him again 2 months later for a new episode of respiratory discomfort. Parents tell you he's been cluttered and coughing since his last episode. Its weight is 6,100 g. What is (are) the possible diagnosis(s) given the history of this child?


You suspect an immune deficiency. If confirmed, what vaccine(s) would be contraindicated in this child?


No newborn screening was offered to this child. For children born in French maternity wards, newborn screening for cystic fibrosis:

Requires signed parental consent for potential genetic research

Is proposed on the first day of life in case of delay in the emission of meconium

Consists of the analysis of the CFTR gene when the immunoreactive trypsin assay is below the threshold of positivity

There are many false positives but few false negatives: this is what we expect from a screening test (we do not want to miss a disease).


This child has a homozygous delta-F508 mutation. What support do you implement?

Oral supplementation of fat-soluble vitamins


Context: A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a "ball" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level.

The examination of the perianal region finds the following externalization at the pushing efforts.  Which of the following is correct?

The radial appearance of the folds is in favor of hemorrhoidal prolapse

The appearance of the lesion is in favor of cancer

The existence of haemorrhages on contact with or at the time of exemptions is in favour of cancerous degeneration.

The painless nature of the swelling is not in favor of hemorrhoidal thrombosis

This is a total externalized prolapse of the rectum


You mention hemorrhoidal prolapse. Regarding your therapeutic care, what is (are) the exact proposal(s)?

Regularization of transit is necessary to limit hemorrhoidal manifestations

This patient must be operated urgently, he risks thrombosis quickly

The regularization of transit and hygiene-dietary rules may be sufficient to relieve the patient

If he remains embarrassed after medical care, surgery may be considered

Hemorrhoids are a risk factor for cancer


Regarding the care and follow-up of the patient, what is (are) the exact proposal(s)?

Once the hygiene-dietary rules are established, if the patient is relieved, there are no other examinations to perform

Surgery should be planned as soon as possible, there is no need to continue pre-operative explorations

The presence of rectal bleeding requires a colonoscopy

To authenticate bleeding, the patient may be offered a stool blood test.

In this context of symptomatic hemorrhoidal disease, colonoscopy can only be considered once the hemorrhoidal problem has been resolved.


A colonoscopy under general anesthesia is performed. It highlights at the level of the sigmoid colon the following image that is not passable. Which of the following proposals concerning iconography is (are) accurate?

It is an irregular and ulcerated lesion suggestive of a malignant tumor

It is an inflammatory colonic diverticulum

The mucosa around the lesion is inflammatory and suggestive of chronic inflammatory bowel disease

This lesion may explain the patient's increased constipation in recent months.

Endoscopic removal of the lesion is necessary to perform a total colonoscopy


The biopsy confirms that it is a well-differentiated lieberkhunian adenocarcinoma. Which of the following proposals concerning the extension and pre-therapeutic assessment is (are) accurate?

The thoraco-abdomino-pelvic CT scan is the reference examination for the extension assessment of this colon cancer

The PET scan must be performed to detect locations not seen on the scanner

The patient cannot be operated on if the colonoscopy is not complete

The determination of CA 125 and CA 19.9 markers is indicated

It is necessary to schedule a new pre-operative anesthesia consultation


There are no metastases. Which of the following proposals for patient care is correct?

The patient's file must imperatively be presented in a multidisciplinary consultation meeting (RCP) before any treatment

Surgery is the gold standard treatment for non-metastatic colon cancer and the only curative option

Preoperative radiotherapy may be offered to improve the chances of local control of this advanced cancer

Chemotherapy may be indicated post-operative depending on the results of the histopathological examination of the operating room

Intraperitoneal intraperitoneal chemohyperthermia can be performed to prevent loco-regional recurrence


You are planning a colectomy. Which of the proposals for the rules of cancer surgery is correct?

A colectomy with tumour safety margins of at least 5 cm is required

A lymph node dissection requires at least 12 lymph nodes for proper assessment of lymph node status

A colectomy with restoration of digestive continuity and without stoma is the rule in this situation apart from the emergency or an intraoperative abnormality

A stoma must be performed because the tumor has evolved and chemotherapy must be started quickly

In case of discovery of peritoneal carcinomatosis during the intervention, it is allowed to postpone the colectomy and to discuss the patient's file again in multidisciplinary consultation meeting


The patient is operated in good conditions, with a restoration of continuity at the same time operative. The report of the histopathological examination concludes that circumlateral adenocarcinoma invades the sub-serosa. There is an invaded lymph node out of the 13 examined. There are vascular embols and perinervous sheaths. There is instability of micro-satellites. Which of the proposals concerning the stage of the disease and its prognosis is (are) accurate?

The prognosis for overall survival at 5 years is 95%

The presence of vascular emboli is a factor of poor prognosis

Peri-nervous sheathing has no impact on prognosis


The postoperative period is marked by the appearance of a fever at 38.5 ° C on the 5th day.   Which of the following is correct?

It is necessary to evoke a complication type of anastomotic fistula

A cytobacteriological examination of urine is indicated in this patient who has undergone urinary catheterization for his procedure

A determination of D-dimer must be carried out

Palpation of the abdominal scar is essential


A wall abscess was removed. The sequels are ultimately simple. The patient leaves the ward on Day 7. Regarding the continuation of the care during the first year, which proposal(s) is(are) accurate?

A colonoscopy should be performed within 6 months as the initial examination was not complete

Given lymph node invasion, adjuvant chemotherapy is indicated

Given the importance of parietal (subserosa) involvement, postoperative radiotherapy should be offered

As part of the patient's management, his colon cancer enters the list of conditions eligible for 100% coverage

Clinical and ultrasound monitoring should be semi-annually


What is the element of anamnesis that makes you propose to the patient an onco-genetic consultation?

The presence of vascular emboli on histological examination


Which of the following cancers is (are) on the narrow spectrum of Lynch syndrome?

Two mnemonics: GOBES and VICE (see the mnemo means tab)


Finally the patient receives adjuvant chemotherapy that he tolerates well. He wishes to resume his professional activity within a month of the end of his chemotherapy. What can you offer him as a doctor?

Encourage them to file an application for recognition as a disabled worker (RQTH)

Write him a certificate of aptitude for the resumption of his professional activity

Send it now to the occupational physician of his company for a pre-resumption visit

Prescribe part-time for therapeutic reasons

Submit an application for an adult disabled allowance (AAH)


A year later, the surveillance scanner shows the following image. Regarding this iconography, which is (are) the exact proposal(s)?

It is a CT scan injected at arterial time

We individualize on this picture the spleen

A hypodense image compatible with liver metastasis is found

This lesion is located in the left liver


This is actually a single liver metastasis of his colorectal cancer. Which of the following proposals for the management of this patient is correct?

His file must be represented in a multidisciplinary consultation meeting (RCP)

Excision surgery can treat this patient curatively

A preoperative PET scan may be indicated to ensure the absence of further distant metastases

Chemotherapy may be offered to assess the tumor's response to treatment

In this patient already operated on the colon, an intervention on the liver is no longer possible


Context: A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago.

Regarding the facial nerve, which proposals are accurate? (one or more possible answers)

Its sensory ganglion is the trigeminal ganglion

His elbow separates his first portion from his second

It separates the second portion from the third


The motor deficit is homogeneous affecting both the upper and lower territory

There is an automatic-voluntary dissociation

We can observe a sign of the eyelashes of Souques

Facial features are deflected to the paralyzed side


What are the additional examinations that you will carry out initially?


What diagnosis do you evoke in front of this aspect?


You diagnose a cholesteatoma. You perform a tonal audiometry of which here is the result. These curves are characteristic of:


You diagnose left-handed conductive hearing loss. You perform an acoumetry. What is the exact proposal(s):

In the Weber test, the sound is lateralized on the left side.

Weber's test will be said to be positive

Weber is neither positive nor negative: he is either lateralized or non-lateralized.

Rinne's test will be said to be negative

In the Rinne test, bone conduction will be better than air conduction


Regarding the innervation of the face and neck:

A section of the right hypoglossal nerve will cause during protraction a deviation of the tongue to the left

The levator muscle of the upper eyelid is innervated by the trochlear nerve

A section of the right vagus nerve at the mediastinal level will lead to paralysis of the right hemilarynx

A section of the left cervical sympathetic trunk will lead to Claude Bernard-Homer syndrome

The lateral rectus muscle is innervated by the abducens nerve


The clinical examination of this patient shows that when the eyes are closed, his left eye does not close completely and that the deviation of the mouth is well obfecled at rest. You propose as early management:


You carry out as an additional examination (an expected answer):

Scanning of the two rocks without injection of contrast medium


You perform a scan of both rocks without injection. On this scanner section of the left rock:


You propose as support for this chollessteatoma (an expected response):

Treatment with amoxicillin-clavulanic acid for fifteen days

An instillation of ofloxacin in ear drops, one dose twice daily for one month

A 6-month consultation for a new otoscopy

Iterative aspirations under a microscope


You operated on this patient by performing a first time of tympanoplasty. You then discuss with him the continuation of his care:

The patient is at risk of residual cholesteatoma

Monitoring will include regular audiogram

The patient is at risk of recurrent cholesteatoma

Monitoring will include regular otoscopy


The patient does not return to the various follow-up consultations you have scheduled. Three years after the surgery, he consults you again urgently for a large vertigo of sudden beginning, appeared since the day before, accompanied by nausea and vomiting. You are diagnosed with left harmonious vestibular syndrome. You will find at the clinical examination:

During nystagmus, a slow deviation of the eyes to the left

At the maneuver of the outstretched arms, a deviation of the index fingers to the left


On otoscopy, you visualize a recurrence of cholesteatoma. Clinical examination shows no involvement of the other cranial pairs. The audiogram shows bone conduction similar to that existing post-operatively. The most likely diagnosis is

Thrombosis of the left internal auditory artery

Lysis of the left lateral semicircular canal


You suspect lysis of the left lateral semicircular canal. You prescribe as additional examinations

Standard X-ray incidence << rock in orbit >>


Context: A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a "lump" under the arm. The blood count finds: Hemoglobin 102 g / L, VGM 79 fL, CCMH 28 g / dl, Hematocrit 36%, Platelets 520 G / L, Leukocytes 8 G / L, PNN 5 G / L Lymphocytes 2.5 G / L, Monocytes 0.5 G / L

You want to specify the abnormalities found on the blood count. What additional examinations are you requesting? (one or more possible answers)


What can be the reasons for the hyperplatektosis? (one or more possible answers)


You examine the patient. He has left axillary lymphadenopathy. It has no hepatosplenomêgalie. Blood pressure is at 130/70. The temperature is 37.1°C at the time of the examination. It has very pale skin and you notice a slight thoracic collateral circulalion. You suspect superior cava syndrome. What signs will you look for in favor of this diagnosis? (one or more possible answers)

This is a sign of hepatocellular insufficiency.

An edema filling the supraclavicular hollows


He actually does not tolerate the lying position well and sleeps with 2 pillows. Suspecting lymphoma pathology, you refer the patient for hospitalization in hematology. A PET scan is performed quickly. About this review, which propositions are true? (one or more possible answers)

This is an examination indicated in the initial assessment of aggressive lymphomas

Tumor metabolism is evaluated by the SUV (Standard Uptake Value)

The patient should be infused with glucose serum


What is your interpretation? (one or more possible answers)

There is supra- and subdiaphragmatic lymph node involvement

It is compatible with an Ann Arbor Stage II

There are many artifacts that hinder interpretation

There is probable damage to the urinary tract


The PET scan shows hypermetabolic axillary and mediastinal lymphadenopathy (SUV> 10). What exploration modalities do you choose in this context? (one or more possible answers)

Cytopuncture of axillary lymphadenopathy

Axillary dissection with extemporaneous examination

Mediastinoscopy and mediastinal mass sampling


You perform a biopsy of an axillary lymph node. The histological report comes back to you: large cells with destroyed architecture, tumor cells expressing CD20. What is the most likely histological diagnosis? (only one answer expected)

Diffuse large cell non-Hodgkin B-cell lymphoma


The diagnosis of diffuse large cell B-cell lymphoma is retained. You perform an osteomedullary biopsy and lumbar puncture which are normal. You want to calculate the usual prognostic score (IPI for international prognostic index) in this patient. What do you need? (one or more possible answers)


What do you offer the patient before starting treatment? (one or more possible answers)

Cardiac ultrasound with ejection fraction measurement


You are starting immunochemotherapy such as rituximab, doxorubicin, vindesine, cyclophosphamide, bleomycin and prednisone. What are the classic side effects of doxorubicin (anthracycline): (one or more possible responses)

Extensive skin necrosis in case of extravasation

Non-alopecic chemotherapies to know for NEC are platinum salts, 5-FU and methotrexate.


Rituximab: (one or more possible answers)

Is an antibody recognizing CD34 surface antigen

May cause cytokine release syndrome on first infusion


At 10 days of chemotherapy, the patient who is at home, calls you because he is feverish with several temperature peaks at 39 ° C and chills. The blood count carried out the day before shows Hemoglobin 91 g / dL, Leukocytes 1.8 G / L, neutrophils 0.4 G / L, Lymphocytes 1.2 GIL, Monocytes 0.2 G / L, Platelets 50 G / L. What are the proposals that apply to the blood count? (one or more correct answers)


You prescribe antibiotic therapy with amoxicillin

You make him do a chest x-ray in town in emergency

You ask him to contact you again after 12 hours of antibiotic treatment


When he arrives in the hematology department, what examinations must be carried out urgently? (one or more possible answers)


After taking blood cultures and an ECBU, what therapeutic attitude do you adopt? (one or more possible answers)

Antibiotic therapy started after blood culture results


Context: A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode.

What late complication(s) may result from contusive eye trauma? Decreased mydriasis of the photomotor reflex

Mydriasis with decreased photomotor reflex


Which symptom(s) would be suggestive of a cataract?


Which symptom(s) would be suggestive of retinal detachment?


Your clinical examination regains a visual acuity measured at 10/10 P2 with a correction in glasses of -1 (-0.50 to 85 °) in the right eye, and << see the hand move >> with -3 (-0.75 to 75 °) on the left eye. What refractive disorder(s) is present in this patient


Intraocular pressure is measured at 18 mm Hg in the right eye and 20 mm Hg in the left eye. The examination of the anterior segment of the right eye is without departure. Examination of the anterior segment of the left eye finds a deep anterior chamber and a total white cataract. The examination of the eye food is unremarkable on the right side and not visible on the left side. What other abnormality(s) of traumatic origin could you find in the anterior segment of the left eye?


What additional examination(s) are you requesting to clarify the condition of the eye structures of the left eye?

Optical coherence tomography (macular OCT).


What examination(s) are needed before cataract surgery?

A measurement of the axial length of the eye


The ultrasound is without particularity to the left eye. You offer the patient cataract surgery on his left eye. What explanation(s) do you give to the patient?

Surgery is performed during a traditional 2-day hospitalization

Anesthesia is most often local or locoregional

Visual recovery cannot be estimated because the fundus is not visible

It is necessary to see the state of the retina (which echo B does not allow) to have a prognosis of visual recovery.

Complications are rare but can lead to loss of function of the eye

The absence of lens will be corrected by a corrective lens


The cataract operation does not go as planned. At the time of phacoemulsification, there is a large posterior capsular rupture.  What is (are) the possibility(s) of correction of aphakia in this case?

Placement of a multifocal implant in the capsular bag

Placement of an anterior chamber implant

Placement of a monofocal implant in the capsular bag


The operation finally tennine well and an anterior chamber implant is placed. Three weeks after the operation the patient consults urgently for a decrease in visual acuity of the left eye associated with a white and painless eye with a calm anterior segment. What diagnosis(s) do you mention?


The visual acuity of the left eye is measured at 5/10 Parinaud 5 with a correction. Intraocular pressure is measured at 20 mm Hg and examination of the anterior segment is unremarkable. Examination of the fundus finds a loss of foveolar reflection. Which additional exam(s) are you requesting:

Macular optical coherence tomography (OCT)

We want to see the macula to objectify an edema of Irvin Gass.


A macular optical coherence tomography (OCT) scan is performed. There is a post-operative macular edema of cataract surgery, which is (are) the exact proposal(s)?

It is accompanied by hemorrhages and cottony nodules

It occurs in post-operative weeks or months

Local or loco-regional anti-inflammatory treatment is often effective


The patient consults again 3 years later because his visual acuity has deteriorated. It is quantifiable with the left eye at 1/1O Parinaud 5 with the best optical correction. In this context of post-traumatic cataract and anterior chamber implant, what diagnosis(s) can (s) be evoked to explain this decrease in visual acuity?


Context: Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters.

After listening to the patient, you seek clarification of certain symptoms.  It seems important to you to look for the presence (or absence) of:


The patient confirms the presence of arthralgia. He had no epistaxis or red eye episodes. On the other hand, it is dyspneic and the Sp02 taken during the consultation is 94% in ambient air. Blood pressure is measured at 110/65 mmHg. The pulse is at 85/minute. You propose to the patient to carry out biological analyzes. You ask the nurse to sample:


With the clinical context, these results point you towards


You turn to vasculitis and decide to hospitalize the patient in the internal medicine department. The rest of the results arrive quickly especially the C-reactive protein which is at 451 mg / L. The available results are shown here. Chronic inflammation alone allows you to explain:


They are looking for each other in direct immunofluorescence

Indirect (direct FI refers to solid biopsies).

They are mainly directed against myeloperoxidase or proteinase 3

They are directed against the cytoplasm of eosinophilic polynuclear

They are directed against the cytoplasm of Hep-2 cells

Their positivity in this patient would direct you to vasculitis with deposits of immune complexes


The ANCA result and urine strip are shown below. You think you need to:

Perform an arteriogram before renal biopsy

Contraindicate renal biopsy since ANCA are positive

Perform a kidney ultrasound before biopsy


You propose an emergency renal biopsy puncture. This will be carried out:

After obtaining the patient's blood type

It will be necessary to think about also ticking the RAI if they are proposed

With a non-fixed sample for immunofluorescence

With a sample for electron microscopy (EM)


This is a histology compatible with pauci-immune vasculitis

The medullary part of the sample allowed the analysis of the glomeruli

There are endomembranous deposits of imrrunoglobulins


This renal histology is consistent with pauciimmune vasculitis. You propose to treat the patient with:


In this context, you choose a therapeutic protocol combining cyclophosphamide, corticosteroid therapy and plasmapheresis. You want to inform the patient about the potential toxicities of cyciophosphamide. You explain the risk(s) of:


You ask for a chest scan. In these images, you can distinguish:


The patient's situation improves after 6 plasma exchanges, corticosteroid therapy (performed by infusion and then relayed at 1 mg / kg / day orally) and cyclophosphamide. You added cotrimoxazole (trimethoprim-sulfamethoxazole) at a dose appropriate to renal function on day one and the patient received ivennecline at an appropriate dose. It is apyretic, dyspnea has disappeared as well as ENT symptoms. Plasma creatinine stabilizes at 140 μmol/L. CRP is less than 5 mg/L. The patient's blood count, 2 weeks before the start of treatment, finds: PNN at 15.87 G / L, PNE at 0 G / L, PNB at 0 G / L, Lymphocytes at 0.84 G / L and Monocytes at 0.84 G / L. You think the results are related to:


Twenty-eight days after the start of treatment, the patient presents with a rash of sudden onset whose photographs are shown to you. C-reactive protein, which was less than 5 mg/L 72 hours previously, is at 115 mg/L. Hemoglobin is at 13.5 g / dL, platelets at 480 G / L, leukocytes at 14 G / L (including 10 G / L neutrophils, 2 G / L eosinophils and 0.9 G / L lymphocytes), creatinine is stable at 140 μmol / L, AST are at 350 Ul / l, ALT at 390 IU / L,  gammaglutamyltransferases (GGT) at 390 IU/L and alkaline phosphatases at 140 IU/L. Emergency liver ultrasound is normal. You mention

Generalized acute exanthematous pustulosis

A parasitic infection on corticosteroids


You mention a synctome of hypersensitivity to cotrimoxazole that you stop immediately. The patient's vaccination record tells you that he received a BCG vaccination at 1 month of age (the subsequent tuberculin tests were all negative), a measles-mumps-rubella vaccination (2 injections), and a diphtheria-tetanus-pertussis-poliomyelitis vaccination whose last booster was made when the patient was 25 years old. He tells you that he has never had chickenpox. For prophylactic purposes, you advise vaccinating the patient with

An anti-pneumococcal vaccination with 2 injections

A DTP booster in the context of immunosuppression


Context: A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be "drugged". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm.

Regarding legislation on sexual violence, what is the exact proposal(s)?

Rape is any act of sexual penetration carried out under threat, coercion or surprise

This is the definition in the Penal Code.


This girl is alone, tells you she is ashamed, and wishes that neither her parents nor anyone around her knew what happened. What is the course of action? (only one exact answer)

You don't look at her until she files a complaint

You ask him to bring an adult of his choice to participate in his care

You only do the integumentary examination but not the gynecological examination


The victim was joined by the 40-year-old mother of a friend. The victim asks you for a medical certificate. What is the exact proposal(s)?

This document is essential if she wishes to file a complaint

You give him the medical certificate, in the presence of the adult of his choice

You give the medical certificate to the judicial police officer on duty at the police station

In case of judicial requisition, you give this certificate to the judicial police officer only if the young woman agrees

If the filing of a complaint is uncertain, the issuance of a medical certificate is not possible


What is (are) the method(s) of drafting the medical certificate?

The medical editor mentions his identity

The victim must prove his identity to the doctor by giving him an identity document

The doctor certifies that the facts reported are credible

The absence of gynaecological traumatic injury must be mentioned in the certificate

Sexual violence results in total incapacity for work of more than eight days


At the end of the clinical examination, which additional examination(s) do you request?


The information you give her persuades the girl to file a complaint to complete your judicial report. You contact the Police. The judicial police officer (OPJ) explains that a police team will come to bring you a document and wait at the hospital for the end of your examination. What is this document? (only one exact answer)


You are requisitioned by the judicial police officer to carry out the examination of the victim and any useful samples. In this context, what sample(s) can you carry out?


At the end of your examination, the judicial police officer wants to know the number of days of total incapacity for work. Regarding total incapacity for work in the criminal sense for this patient, what is (are) the exact proposal(s)?

Total incapacity for work must be mentioned on the medical certificate

Total incapacity for work in the criminal sense corresponds to functional discomfort in carrying out the gestures of daily life

Total incapacity for work in the criminal sense corresponds to the number of days of absence from work

Total incapacity for work does not apply to minors

Total incapacity for work only makes sense if it is strictly greater than 8 days


What treatment(s) can you urgently prescribe to this girl, with her agreement and that of the adult accompanying her?

Antidepressant treatment that inhibits serotonin reuptake

In prevention of infection with Chlamydia trachomatis (in 2022, treatment is based on Doxycicline 8 days).


What element(s) should be included in the information to be provided to the victim?

Contact details of a victim support association


Four days later, the victim has side effects following taking triple antiretroviral therapy. She is furious because she says she was not informed of these effects. Regarding medical information, what is the exact proposal(s)?

The burden of proof of information lies with the patient initiating a procedure

The information must be delivered orally

The information must be provided in writing

Information must be fair, clear and appropriate

A confirmation of the delivery of the information must be signed by the patient


The girl comes back to see you, pregnant with 9 weeks of amenorrhea, as a result of sexual violence, she tells you. What is the exact proposal(s)

Parental consent is required to carry out a voluntary termination of pregnancy

The girl may be accompanied by an adult of her choice for the different stages of the voluntary termination of pregnancy

The girl can benefit from a voluntary termination of pregnancy by medical means

The limit is 7 SA for the drug route. This duration may change in the coming months/years, remember to check the latest recommendations of the HAS (and do not hesitate to let us know this proposal if it becomes true).

The girl can wait up to a term of 16 weeks of amenorrhea to request a voluntary termination of pregnancy

Due to the context, the cooling-off period is cancelled


Context: A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 / min, heart rate at 110 / min, blood pressure at 105/70 mmHg. His Glasgow score is rated at 13.

In the table of this patient, which of the following parameter(s) is (are) suggestive of sepsis with poor prognosis?


Establishment of a central venous first route

Filling with synthetic macromolecules (1L on the first hour)

Colloids are no longer used to fill patients (very limited indications in intensive care, this is not to be known for NEC).


Which of the following exam(s) is part of your first-line assessment?


The CBC targets anemia at 121 g/L, leukocytosis at 4600 G/L (including 3800 PNN), CRP at 254 mg/L and PCT at 3.5 μg/L. The ionogram is normal, kidney function is normal. Arterial blood gases under nasal oxygen 6L/min are: pH 7.45 - pC02 30 mmHg - p02 65 mmHg - HC03- 25 mmol / L. A chest CT scan is performed immediately. What is your interpretation of this scanner?


Blood cultures are ongoing and legionella antigenuria is negative. Which of the following infectious agents may be responsible for this picture at this stage of your investigations?

Which would be serotype 2 here (not detected by antigenuria, which can also be falsely negative).


The patient is immediately transferred to intensive care where he is immediately intubated in the face of respiratory exhaustion. Do you prescribe anti-infective treatment(s) at this stage?


The probabilistic anti-infective treatment implemented combines cefotaxime, spiramycin and oseltamivir. A bronchoalveolar lavage is quickly performed. It highlights many cysts of Pneumocystis jirovecii. How do you adjust your treatment knowing that you are diagnosed with pneumocystosis?

PAO2 is less than 70 mmHg. Corticosteroid therapy will reduce fibrosis due to inflammatory overstimulation.


In view of this diagnosis, an HIV serology has been performed and is positive. What additional exam(s) do you perform?


With cotrimoxazole and corticosteroids, the patient's condition improves rapidly and he is extubated after 48 hours. He began to refeed orally. No other infectious agents were identified in all the samples taken. CD4 count is 19/mm3 (4.8%) and viral load is 159,000 copies/ml. On Day 4 of the management, concerning antiretroviral treatment, which of the following proposals is accurate?

Introduction of dual therapy with protease inhibitor and entry inhibitor

Introduction of triple therapy with protease inhibitors and two non-nucleoside reverse transcriptase inhibitors

Introduction of triple therapy with protease inhibitor and two nucleoside reverse transcriptase inhibitors

Introduction of triple therapy with integrase inhibitor and two nucleoside reverse transcriptase inhibitors

We'll let him recover from his lung infection first ☺


The trend continues to be favourable with cotrimoxazole. Corticosteroids were discontinued on Day 6 and antiretroviral therapy was not initiated. On Day 10 of the treatment, the fever reappears with a scarlatiniform rash of the trunk and face. What is (are) your hypothesis(s)?

Pneumocystis resistance to cotrimoxazole

Rebound of pneumocystosis following discontinuation of corticosteroids

Antiretrovirals have not yet been started.


The hypothesis of an allergy to cotrimoxazole is retained. What sign(s) of gravity are you looking for?

This is not especially a sign of gravity


There is no sign of severity and the rash regresses within a few days following the reduction of cotrimoxazole doses. You decide on Day 15 to introduce antiretroviral treatment. Which of the following will be useful for the choice of initial antiretroviral therapy?


The result of HBV serology is as follows: HBsAg positive, HBeAg positive, anti-HBc IgM negative, anti-HBc IgG positive, anti-HBe antibodies and HBs negative. HBV DNA PCR is high (10 million Ul/ml) and transaminases are 2.5 times the norm. Which of the following is correct?

It is a hepatitis B virus without pre-core mutation

The HBe antigen is positive so it is not mutated

Antiretroviral therapy should ideally include tenofovir

Ribavirin should be added to antiretroviral therapy

HBV serovaccination should also be given to the patient


Triple antiretroviral therapy is initiated on Day 15. Which of the following proposals for support after D15 is correct?

Continuation of cotrimoxazole treatment at current doses for another week

Secondary prophylaxis (after the end of attack therapy) low-dose anti-pneumocystosis ar cotrimoxazole

Initiation of primary prophylaxis of esophageal candidiasis with fluconazole

Initiation of primary anti-toxoplasmosis prophylaxis with low-dose pyrimethamine

Maintenance of primary toxoplasmosis and secondary pneumocystosis prophylaxis for 2 years


What other measure(s) can you personally take?


Context: At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170/100 mm Hg. His pulse is 75/min, regular. You suspect an ischemic stroke.

Which lesional location(s) do you think are likely?


Realization of a Doppler ultrasound of the supra-aortic trunks

High blood pressure figures are tolerated in ischemic stroke.


What sequence(s) should the MRI include?


Here are two images of the MRI performed:

Left sylvian hypersignal in FLAIR sequence

Right occipital hypersignal in FLAIR sequence

Left sylvian hypersignal in diffusion sequence

Right silvian hypersignal in diffusion sequence

Left sylvian hyposignal in scattering sequence


Brain MRI reveals a recent lesion visible in diffusion sequence in the superficial left sylvian territory. It also finds a hypersignal in FLAIR sequence in the right, ancient occipital territory. There is no bleeding lesion or obstruction of the proximal large vessels. In view of these MRI results and the clinical context, which pathophysiological hypothesis do you think is most likely? (only one answer expected)


What is your immediate therapeutic proposal? (only one answer expected)

Unfractionated parenteral hypocoagulant heparin

We are not in a case of late time. In addition, the clot is not proximal, which would make thrombectomy complicated.


Following the MRI, the patient was admitted to the neurovascular unit (UNV) and underwent intravenous thrombotyposis. The motor deficit has partially recovered, phasic disorders persist. What is(are) the element(s) of your prescription during the first 24 hours?

Subcutaneous insulin therapy if blood glucose above 1.8 g/L

Multiple daily clinical monitoring by NIHSS score


At 48 hours of evolution, the patient remains aphasiac. There persists a predominant distal right brachial motor deficit and oral feeding is resumed without discomfort. He did not present any complications. What is (are) the objective(s) of physiotherapy management at this stage?

Analytical reinforcement of motor skills

Passive mobilizations of the lower right limb


To confirm your main etiological hypothesis, you prescribe

A Doppler ultrasound of the supra-aortic trunks


This patient has Broca's aphasia. Which characteristic(s) are compatible with this diagnosis?


The holter ECG shows paroxysmal atrial fibrillation. Cardiac ultrasound (transthoracic and transesophageal) and Doppler ultrasound of the supraaortic trunks are normal. The lipid and glycemic balance is normal. Blood pressure normalized. What is (are) the element(s) of your exit prescription?


What is(are) your non-drug prescription (s)?

Not acute because the patient can continue to recover


You see the patient again in follow-up consultation at 3 months. There is still clumsiness in the right hand and a reduction in fluency, as well as fatigability. He is autonomous for most activities of daily living but has not been able to resume his professional activity. He also complains of attention and sleep disorders, his weight is 65 kg. He continues his anticoagulantoral treatment with anti-vitamin K. What is your diagnostic orientation in the face of this clinical evolution (only one expected response)


What medico-social measure(s) can you propose?

Constitution of a file with the Departmental House of Disabled Persons for allocation of the Disabled Adult Allowance (AAH)

Preparation of a file with the Departmental House of Persons with Disabilities for recognition of quality disabled worker


Regarding his long-term oral anticoagulant treatment, which is(are) the exact proposal(s)?

The INR control must be at least monthly

In case of hemorrhage, PPSB acts faster than vitamin K

In case of INR at 5, vitamin K intake is recommended

If he is asymptomatic, he simply has to skip a catch.


Context: A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable.


You suspect secondary syphilis. Which symptom(s) or examination sign(s) presented by the patient is (are) suggestive with this diagnosis?

The localization on the trunk of the eruption


Which of the following symptoms can also be highlighted in secondary syphilis?


To reinforce your diagnosis, you look for the existence of symptomatic primary syphilis that preceded the current rash. Which of the following proposals for syphilitic chancro is (are) accurate?


You do not find at the interrogation any element in favor of a syphilitic chancre. The patient informs you, however, that he was diagnosed with syphilis 10 years ago and that he received treatment. Which of the following tests do you request to confirm the diagnosis of secondary syphilis?


The TPHA is positive (+++) and the VDRL is 1/64. In context, what interpretation(s) do you make of it?

Previously treated syphilis serological scar


Apart from syphilis, what is the situation(s) where a VDRL can be positive?


Apart from syphilis, what is the situation(s) where APHD can be positive?


You are looking for another sexually transmitted disease(s) in this patient. Which exam(s) are you requesting?


Because the patient is HIV-negative, what treatment(s) do you put in place, in the absence of drug allergy, to treat secondary syphilis?

Ceftriaxone 500 mg, single intramuscular administration

Azithromycin 1 g, single oral administration

Treatment of Chlamydia trachomatis (today it is Doxycicline 8 days in first line)

Benzathine benzylpenicillin G 2.4 MUI, single intramuscular administration

Penicillin G 20 MUI, intravenous administration for 15 days

Doxycycline 200 mg, single oral administration


The patient received a single injection of benzathine benzylpeflicillin G 2.4 MUI. A few hours later, he complained of headaches and myalgia. The temperature is 38°C and lesions on the palms and plants appear more numerous and larger. What diagnosis(s) do you mention?

Taxidermy with macula-papular exanthema type

Drug-induced hypersensitivity syndrome (DRESS)


In order to ensure the effectiveness of benzathine benzylpenicillin G 2,4 MIU treatment, when should you recheck TPHA and VDRL in this patient? (one or more correct answers)


The questioning of the patient taught you about the existence of several partners in the previous months, without protection from sexual intercourse. Only his most recent partner was able to be contacted by the patient and present for consultation. The last unprotected sex between them was 3 weeks ago. TPHA and VDRL are negative. What is the possible interpretation(s) of the partner's serology?


An injection of benzathine benzylpenicillin G, after checking for allergy


You see the patient again 6 months after treatment of secondary syphilis with benzathine benzylpenicillin G 2.4 M. It is asymptomatic and the rash is gone. The VDRL is 1/16, the TPHA is positive (+). As a reminder, in pre-therapeutics, the TPHA was positive (+++) and the VDRL was 1/64. What interpretation(s) do you make?

Need for a new injection of benzathine benzylpenicillin G 2,4 MIU


Context: A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500/mm3, Polynuclear neutrophils=2200/mm3, Polynuclear eosinophils=100/mm3 Basophilic polynuclears=0/mm3,Lymphocytes=1700/mm3Monocytes=500/mm3,Hemoglobin=9.2g/dL,VGM=118µ3, platelets=150000/mm3. The blood ionogram and kidney function are normal.

Which additional exam(s) are you considering?

The statement does not speak of first intention, so it is true since the myelogram is well envisaged in the prse in charge of a potentially central anemia.


The reticulocyte count is 70 OOO/mm3. A myelogram is performed. The examination finds the presence of a rich marrow, with erythroblasts of large size, an asynchrony of nucleocytoplasmic maturation, the presence of giant metamyelocytes and hypersegmented polynuclear cells. There is no excess of blasts. What is your diagnosis?


The requested assessment finds a serum concentration of vitamin B12 at 75 ng / L (N>200). The dosage of vitamin B9 is normal. Which additional exam(s) do you prescribe to complete the assessment?

Determination of anti-transglutaminase antibodies

Determination of anti-nuclear antibodies

Determination of anti-intrinsic factor antibodies


Anti-intrinsic factor antibodies are absent and upper gastrointestinal endoscopy finds pallor of the mucous membrane of the antrum and gastric body with excessive visibility of the small vessels. There is no esophagitis. Samples taken from the gastric body and the antrum reveal a rarefaction of the density of the glands with the presence of sectors of the epithelium consisting of intestinal type cells. Absence of visible pathogen. There is in the chorion a moderate lymphoplasmacytic infiltrate without neutrophil polynuclear. What is the real proposal(s)?

Chronic gastritis with intestinal metaplasia


What is (are) in this patient the predisposing factor(s) to this atrophic pangastritis with intestinal metaplasia?

the sequelae of a Helicobacter pylori infection


What consequence(s) does this atrophic gastritis with intestinal metaplasia expose?


Seven years later, the then 58-year-old patient consulted the Emergency Department for ascites of progressive onset within 15 days. It has appeared for 3 years a non-insulin-requiring diabetes treated with metformin. He drinks about 2 bottles of wine a day. The patient always takes esomeprazole 40 mg daily and an IM injection of vitamin 812 every month. No control endoscopy was performed. The biological assessment shows: Leukocyles at 7700/mm3, neutrophils at 3200/mm3, polynuclear eosinophils at 200/mm3, lymphocytes at 3500/mm3, hemoglobin at 9.3 g/dL, MCV at 82 μ3 platelets at 110 0OO/mm3, AST at 56 IU (N<40), ALT at 43 IU (N<40), TP at 54%, Total bilirubinemia at 87 μmol/l. You perform an ascites puncture of which here are the results: proteins at 15g / L and elements: 500 / mm3 including 70% neutrophils, 20% lymphocytes, 10% monocytes. What diagnosis do you make?

Rupture of hepatocellular carcinoma in the peritoneum


You are diagnosed with ascites fluid infection. Which probabilistic antibiotic therapy(s) is/are recommended as a first-line treatment?


How will you confirm the diagnosis of cirrhosis with certainty in this patient? (one or more correct answers)

Confirmatory diagnosis of cirrhosis is histological


As part of the screening for viral hepatitis, what test(s) do you perform on this patient?


The evolution of the episode is favorable under antibiotics. The patient no longer has ascites. You set up a long-term follow-up. What measure(s) do you propose?

Secondary prevention of ascites fluid infection


How do you screen for hepatocellular carcinoma (single response)?


During follow-up, a 2 cm segment IV hepatic nodule is highlighted. You perform a CT scan to characterize it. What CT characteristic(s) are you looking for in favor of hepatocellular carcinoma?


The CT scan reveals a spontaneously hypodense tumor, taking the contrast at arterial time and washing at portal time. The diagnosis of hepatocellular carcinoma is made. Which first-line treatment(s) will be discussed?


The patient is treated with radiofrequency. Two years later, his liver function deteriorated with the onset of refractory ascites. He also has a recurrence of his hepatocellular carcinoma as a new 3 cm nodule. He is 62 years old and you mention the possibility of a liver transplant. What are the prerequisites?

Absence of extrahepatic metastasis of hepatocellular carcinoma

Absence of endoscopic portal hypertension


Context: Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception.

Which of the following diagnoses can explain this picture?

Attention deficit disorder with or without hyperactivity

Persistent delusional disorder of somatic type


At Mrs. B's insistence, the general practitioner finally agreed to prescribe a brain scan without injection. In the event of hypochondria (or excessive fear of having a disease), indicate the exact proposal(s).

The prescription of this examination may maintain the disorder

The normality of this examination will provide lasting reassurance to the patient.

The normality of this examination is necessary to confirm the diagnosis

An abnormality on this examination would rule out the diagnosis of hypochondria

The doctor-patient relationship may have influenced this prescribing decision


The brain scan without injection performed during the week shows no abnormalities. Mrs. B consults the same doctor again and asks him to prescribe this examination again. She considers it to be << false results >> and explains that they want to make <<her look crazy but that they have not closed everything >>. Mrs. B states that she has a metal object in her brain following surgery. This object is not mentioned in the report of the scanner, so it would be according to her images of someone else. She wants to perform a new scanner in another radiology practice. We note in the words of Mrs. B.:

The patient does not seem to be hiding the truth: she really believes what she says.


The general practitioner having refused to prescribe a new scanner, Mrs. B decides to consult the same day at the emergency reception service (SAU) closest to her home. She refuses the nurse to take vital constants and threatens to commit suicide << like my father >> she says, if she is not examined by a neurosurgeon. When she is told that there is no neurosurgeon in the facility, Mrs. B gets up and walks to the exit without a word. Which of the following indicates a high suicidal risk in Mrs. B.?


The reception and orientation nurse tries to restrain Mrs. B but she threatens her with a pair of scissors that she has taken out of her bag. Which of the following is correct about physical restraint?

It is justified by the immediate self-aggressive risk

It is justified by the immediate hetero-aggressive risk

She requires an admission measure in psychiatric care under duress

It must be declared secondarily to the liberty and detention judge


Faced with self-threatening and hetero-aggressive threats, it is decided to resort to physical restraint. As the patient refuses any oral sedative treatment, an intramuscular injection of a sedative antipsychotic is prescribed. Which of the following considerations led to a preference for the class of antipsychotics over that of benzodiazepines in this case?

It is true that they do not have respiratory adverse effects but this is not at all a consideration to take into account since the patient has no respiratory history.


Once Mrs. B is sedated, the physical restraint is lifted. The inventory of his belongings does not show any other dangerous object and makes it possible to find the report of the scanner. Upon awakening, psychiatric advice is sought. Mrs. B again exposes her conviction of having been deceived by the radiology office in front of the absence of metallic foreign body. She explains that << they are in cahoots with the intermeditators who point my thoughts... but I'm not going to obey them even if they mess me up... I'm not going to kill my mother... unless she's in them...I mean my mother is me actually... >>. We note in the words of Mrs. B.:

Incomprehensible and several degrees above


Which of the following mental disorders could explain the entire clinical picture?

Depressive episode with psychotic features


The patient agrees to provide contact information for her mother who goes to the emergency room. She is received alone and then with her daughter who is told of the need for psychiatric hospitalization in another institution. The patient is reluctant to hospitalize in psychiatry but would accept to be hospitalized for << extraction of intermeditation electrodes >>. What orientation(s) do you recommend?

Admission to Conventional Third Party Psychiatric Care (PTDC)

Admission to Psychiatric Care at the Request of a Third Party in Emergency (UTDPS)

Admission to psychiatric care for imminent peril (SPPI)

Admission to psychiatric care by decision of the representative of the state (SPDRE)


The anamnesis is completed in the psychiatric ward where Mrs. B was hospitalized at the request of a third party. Mrs. B, who lives with her mother, has been complaining of trouble concentrating and paying attention for more than a year and has sometimes been soliloquizing for at least six months. She no longer goes out and has gradually abandoned her usual activities, especially social ones. Unemployed after the non-renewal of a COD, she has not taken any steps to find work. The diagnosis of schizophrenia is made and pharmacological treatment is indicated. Which of the following should be part of the pre-therapeutic assessment:


The pre-therapeutic assessment performed shows no abnormality and Mrs. B is not pregnant. Treatment with oral risperidone is started. After 4 weeks of treatment, neurological examination now shows a marked tremor of the extremities and a bilateral and symmetrical cogwheel. Mrs. B is less vehement but remains determined to obtain the surgical extraction of the device that she believes would have been implanted to manipulate it. Which of the following hypotheses could explain the persistence of positive symptoms?

This cannot be a cause of persistence of hallucinations.

The patient is hospitalized and the actual intake of treatments is monitored.

Partial dopaminergic agonist properties of the molecule


The same treatment is continued for 4 more weeks. Mrs. B continues to report a manipulation of her thoughts but no longer plans to resort to surgery and recognizes that the treatment does her good. The discourse and thought remain disorganized but the first home leaves went well and a release is envisaged. Faced with the persistence of cognitive complaints about attention and concentration, a neuropsychological assessment is carried out which shows a marked alteration of executive functions. To what can you attribute this objective alteration?


Given the persistence of hallucina1ions and disorganization after several months of treatment, it was decided to replace risperidone with another atypical antipsychotic. After 3 months of treatment with olazanpine at optimal dosage, Mrs. B's disorders remain very disabling. You decide to change the antipsychotic treatment again. Which of the following options should be considered first?

Replacement with a typical antipsychotic

Potentiation by the addition of a typical antipsychotic

Potentiation by the addition of a thymoregulator


Which of the following is an advantage(s) of clozapine therapy in this patient

Superior efficacy to other antipsychotics in treatment resistance

Lower risk of inducing metabolic syndrome

Lower risk of extrapyramidal side effects

Possibility of resorting to a delayed form in case of poor compliance


The symptomatology improves markedly with clozapine until Mrs. B considers working again. Which of the following measures can (which) specifically promote this project?

Application for recognition of the status of disabled worker

Use of an Establishment and Work Assistance Service


Context: A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines.

Among the risks associated with this trip, what are the 2 potentially most serious?

Accidents in the broad sense are the leading cause of death when travelling abroad


What is (are) the possible preventive attitude(s) for this stay vis-à-vis the malaria risk?

Daily intake from the first day + one week after return

She has a psychiatric history, which contraindicates mefloquine


What information(s) do you give him about the yellow fever vaccine?

Vaccine to be recorded on a WHO-approved international immunization record

Vaccine that should not be given on the same day as typhoid vaccine


The patient travels to Côte d'Ivoire 🇨🇮 with antimalarial chemoprophylaxis with doxycycline. What should she remember as information about taking this medicine? (one or more answers are true)

To be stopped on the day of return to France

Must be combined with mefloquine due to prolonged stay


Three months later, on the day of her return to France, the patient comes to your office because, for 2 days, she has not felt well and has pollakiuria with urination burns. During your discussion, she tells you that she had abdominal pain and diarrhea for a few days a little more than a month before her return that led her to stop doxycycline, thinking that this drug was the cause. Which of the following clinical signs is the most important to collect when deciding what to do?


The patient is not febrile and you are moving towards simple cystitis. The urine strip is positive. At this stage, what is the most relevant complementary examination? B. Search for

Simple cystitis does not require ECBU (unlike cystitis at risk of complications)


You do not carry out any additional examination. Which of the following treatment options will you choose as a first-line treatment for this patient?


What other recommendation(s) do you make?

Do a follow-up ECBU in 72 hours (3 days)

This advice is relevant in case of recurrent cystitis (we are in the case of simple cystitis)

Do a vesicorenal ultrasound at a distance from the current episode


Ten days later, the patient returns to your office with her partner. She tells you that the urinary signs disappeared 2 days after the treatment but that, for 4 days, she had several outbreaks of high fever with chills and sweats. She complains of stubborn headaches, nausea and abdominal pain with loose stools. The patient is apyretic, her clinical examination is normal, there is in particular no meningeal syndrome. Which of the following diagnoses should you mention first in this patient?


Which of the following clinical elements supports the diagnosis of malaria in this patient?

There is no link between cystitis and malaria

Discontinuation of doxycycline 1 month before returning to France

Periodic/intermittent fever is common in malaria.


You urgently carry out a check-up on this patient, the results of which are as follows. Which one(s) is the most suggestive of malaria diagnosis?


Which exam(s) will allow you to make the diagnosis of malaria now?


The blood smear is 0.5% positive for Plasmodium falciparum. The patient does not vomit and wishes to go home. What first-line care do you offer her knowing that she is not pregnant?

Her platelets are less than 50 G / L (question 11) so she has a hospitalization criterion. The statement is misleading because the patient's wish is always important and it is he who has the last word (we can not force this patient to be hospitalized), but the question is specifically about "what we offer her": we offer her hospitalization.


You cannot treat this patient on an outpatient basis. Why (one or more possible answers)?


After 3 days of hospitalization, the patient is apyretic with a negative thick drip smear and can be discharged. At what time(s) do you organise biological controls?

On the 5th day of the start of treatment

On the 7th day of the start of treatment

J3, J7, J28 😊 . It fell twice, so that's to know.

On the 21st day of the start of treatment

On the 28th day of the start of treatment


Context: A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.

Which clinical sign(s) would direct you to Pancoast-Tobias syndrome? Give the correct answer(s).

A deficit of the interosseous muscles of the hand

There are 4 palmar interosseous and 4 dorsal interosseous. They are innervated by the C8 Th1 ulnar nerve, which is affected in Pancoast-Tobias syndrome.

It is a symptom found in alternating syndromes for example

The ulnar nerve innervates the fifth finger and medial half of the fourth.

Ptosis - Myosis - Enophtalmos is part of another syndrome 😉


The patient does not have an impairment in the general condition. Which of the following signs is the one that points to a joint cause of pain? Give the correct answer(s).

Localization of pain on the anterior side of the shoulder

Joint effusion is often a sign of a local inflammatory cause

Pain on palpation of the delto-pectoral sulcus


Which of these muscles is (are) part of the rotator cuff? Give the correct answer(s).

The little circle is one of them. Unfortunately, you have to learn these muscles - this question often falls, whether in IQ or PD.


The clinical examination reveals an active abduction of normal but painful amplitude of the shoulder. There is a painful arc with active abduction pain between 60 ° and 120 °. The lateral rotation is of normal and symmetrical amplitude. The passive elevation of the upper limb in internal rotation and antepulsion is painful. The following clinical maneuver is painful while other cuff muscle tensioning maneuvers are painless. Which tendon is responsible?


You do a standard X-ray to the patient (below). Which of these proposals is the exact answer(s)? Give the correct answer(s).

There is a decrease in the height of the space under acromial

There is calcification of the rotator cuff tendons

There is osteolysis of the major tubercle


At this stage of management, which additional imaging test(s) of the right shoulder can you request? Give the correct answer(s).

MRI and ultrasound are the two tests that directly visualize the tendons.


The sonographer answers that it is an unruptured tendinopathy of the supraspinatus. You prescribe shoulder rehabilitation. In this patient, what is(are) the objective(s) of physiotherapy? Give the correct answer(s).

The question insists on 'this patient' who does not have passive range of motion.


After a month and 15 sessions of physiotherapy, the patient is still as painful when raising the shoulder. Which strategy(s) is relevant? Give the correct answer(s).

The CT scan is not very useful for the study of tendons, MRI is preferred.


The patient was able to return to work. Trying to catch up with a slide on a scaffolding, he has complete functional impotence of the right upper limb. Here is the front X-ray of the right shoulder. What element(s) does it bring you? Give the correct answer(s).

There is a fracture of the surgical cervix of the humerus

There is an anteroinferior glenohumeral dislocation

There is an acromioclavicular disjunction


Before proceeding to reduce this dislocation, you examine the sensitivity of the stump of the shoulder. An isolated abnormality at this level is in favor of nerve damage: