{"_id":"annales-2018-dp-7-qi-1","context":"You see a couple again in consultation due to primary infertility. They have been in a relationship for 8 years. Reports have been regular and unprotected for 18 months. There have been no pregnancies to date. Mrs. B. is 29 years old; She is Executive Secretary. She has a history of a mother with type 2 diabetes and a brother with type 1 diabetes. It weighs 60 kg for a height of 164 cm (BMI 22 kg\/m2). She does not take long-term treatment. It is G0P0. Its cycles are irregular, ranging from 35 to 65 days, without hot flashes. Mr. B., 32 years old, is a computer engineer. He has a history of allergic asthma and a bimalleolar fracture in adolescence following a skiing trauma. He is not currently taking any treatment. He practices triathlon in competition and trains an average of 10 hours per week (2 hours of indoor weight training, 3 hours of running, 1 hour of swimming and 4 hours of cycling on weekends). He does not smoke or consume alcohol very rarely. It weighs 64 kg for a height of 184 cm (BMI 18.9 kg\/m2). There is no notion of recent genital infection, nor of libido disorder. ","enonce":"Regarding Mr. B, he gives you the results of the spermogram that you had prescribed during your previous consultation. Ejaculate volume: 3 mL (1.5 - 5).  Sperm concentration: 4 million \/ ml (N>15). Progressive mobile forms: 10% (N>32). Typical forms: 1% (N>4). Living forms: 69% (N>58) Agglutinates: none. Leukocytes: absence. Which of the following characteristics do you retain to describe this ejaculate? ","item":"annales-2018-dp-7","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Hypospermia","justification":""},{"idx":1,"correct":true,"proposition":"Oligospermia","justification":""},{"idx":2,"correct":true,"proposition":"Asthenospermia","justification":""},{"idx":3,"correct":true,"proposition":"Teratospermia","justification":""},{"idx":4,"correct":false,"proposition":"Necrospermia","justification":""}],"type":"dp"}
{"_id":"annales-2018-dp-7-qi-2","context":"You see a couple again in consultation due to primary infertility. They have been in a relationship for 8 years. Reports have been regular and unprotected for 18 months. There have been no pregnancies to date. Mrs. B. is 29 years old; She is Executive Secretary. She has a history of a mother with type 2 diabetes and a brother with type 1 diabetes. It weighs 60 kg for a height of 164 cm (BMI 22 kg\/m2). She does not take long-term treatment. It is G0P0. Its cycles are irregular, ranging from 35 to 65 days, without hot flashes. Mr. B., 32 years old, is a computer engineer. He has a history of allergic asthma and a bimalleolar fracture in adolescence following a skiing trauma. He is not currently taking any treatment. He practices triathlon in competition and trains an average of 10 hours per week (2 hours of indoor weight training, 3 hours of running, 1 hour of swimming and 4 hours of cycling on weekends). He does not smoke or consume alcohol very rarely. It weighs 64 kg for a height of 184 cm (BMI 18.9 kg\/m2). There is no notion of recent genital infection, nor of libido disorder. ","enonce":"Which of the following clinical situations could explain the results obtained on this spermogram ","item":"annales-2018-dp-7","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Sequelae of mumps orchitis","justification":""},{"idx":1,"correct":false,"proposition":"Bilateral agenesis of vas deferens","justification":""},{"idx":2,"correct":true,"proposition":"Y-chromosome microdeletion","justification":""},{"idx":3,"correct":true,"proposition":"History of cryptorchidism","justification":""},{"idx":4,"correct":false,"proposition":"Chronic prostatitis","justification":""}],"type":"dp"}
{"_id":"annales-2018-dp-7-qi-3","context":"You see a couple again in consultation due to primary infertility. They have been in a relationship for 8 years. Reports have been regular and unprotected for 18 months. There have been no pregnancies to date. Mrs. B. is 29 years old; She is Executive Secretary. She has a history of a mother with type 2 diabetes and a brother with type 1 diabetes. It weighs 60 kg for a height of 164 cm (BMI 22 kg\/m2). She does not take long-term treatment. It is G0P0. Its cycles are irregular, ranging from 35 to 65 days, without hot flashes. Mr. B., 32 years old, is a computer engineer. He has a history of allergic asthma and a bimalleolar fracture in adolescence following a skiing trauma. He is not currently taking any treatment. He practices triathlon in competition and trains an average of 10 hours per week (2 hours of indoor weight training, 3 hours of running, 1 hour of swimming and 4 hours of cycling on weekends). He does not smoke or consume alcohol very rarely. It weighs 64 kg for a height of 184 cm (BMI 18.9 kg\/m2). There is no notion of recent genital infection, nor of libido disorder. ","enonce":"The clinical examination of Mr. B. notes a penis measured at 6 cm and a testicular volume of 10 and 12 ml. Pubic hair is losangic in appearance. There is no such thing as gynecomastia. Which of the following biological assays do you think is essential to carry out in this context? ","item":"annales-2018-dp-7","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"SHBG","justification":""},{"idx":1,"correct":false,"proposition":"Prolactin","justification":""},{"idx":2,"correct":false,"proposition":"Inhibin B","justification":""},{"idx":3,"correct":true,"proposition":"Total testosterone","justification":""},{"idx":4,"correct":true,"proposition":"FSH","justification":""}],"type":"dp"}
{"_id":"annales-2018-dp-7-qi-4","context":"You see a couple again in consultation due to primary infertility. They have been in a relationship for 8 years. Reports have been regular and unprotected for 18 months. There have been no pregnancies to date. Mrs. B. is 29 years old; She is Executive Secretary. She has a history of a mother with type 2 diabetes and a brother with type 1 diabetes. It weighs 60 kg for a height of 164 cm (BMI 22 kg\/m2). She does not take long-term treatment. It is G0P0. Its cycles are irregular, ranging from 35 to 65 days, without hot flashes. Mr. B., 32 years old, is a computer engineer. He has a history of allergic asthma and a bimalleolar fracture in adolescence following a skiing trauma. He is not currently taking any treatment. He practices triathlon in competition and trains an average of 10 hours per week (2 hours of indoor weight training, 3 hours of running, 1 hour of swimming and 4 hours of cycling on weekends). He does not smoke or consume alcohol very rarely. It weighs 64 kg for a height of 184 cm (BMI 18.9 kg\/m2). There is no notion of recent genital infection, nor of libido disorder. ","enonce":"The patient gives you a biological assessment that he had carried out before your consultation and which indicates the following results: Hb at 14.3 g \/ dL, total testosterone at 5.67 ng \/ ml (N: 2.5 - 10.0), LH at 5.4 IU \/ L (N: 2 - 6) and FSH at 15.SUI \/ L (N: 2 - 8). Which of the following clinical situations can (can) give this clinical-biological picture? ","item":"annales-2018-dp-7","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Side effect of androgen doping","justification":""},{"idx":1,"correct":false,"proposition":"Syndrome de Klinefelter","justification":""},{"idx":2,"correct":false,"proposition":"Prolactin adenoma","justification":""},{"idx":3,"correct":false,"proposition":"Hypogonadism related to si:1ortive intensive activity","justification":""},{"idx":4,"correct":true,"proposition":"Y-chromosome microdeletion","justification":""}],"type":"dp"}
{"_id":"annales-2018-dp-7-qi-5","context":"You see a couple again in consultation due to primary infertility. They have been in a relationship for 8 years. Reports have been regular and unprotected for 18 months. There have been no pregnancies to date. Mrs. B. is 29 years old; She is Executive Secretary. She has a history of a mother with type 2 diabetes and a brother with type 1 diabetes. It weighs 60 kg for a height of 164 cm (BMI 22 kg\/m2). She does not take long-term treatment. It is G0P0. Its cycles are irregular, ranging from 35 to 65 days, without hot flashes. Mr. B., 32 years old, is a computer engineer. He has a history of allergic asthma and a bimalleolar fracture in adolescence following a skiing trauma. He is not currently taking any treatment. He practices triathlon in competition and trains an average of 10 hours per week (2 hours of indoor weight training, 3 hours of running, 1 hour of swimming and 4 hours of cycling on weekends). He does not smoke or consume alcohol very rarely. It weighs 64 kg for a height of 184 cm (BMI 18.9 kg\/m2). There is no notion of recent genital infection, nor of libido disorder. ","enonce":"You mention a possible microdeletion of the AZ region. F of the Y chromosome. Before prescribing the molecular genetic analysis, you want to confirm the spermogram data on a new collection three months later. The patient takes advantage of this time to ask you for some nutritional advice about his sports practice. Which of the following proposals is (are) accurate about your patient's sports practice? ","item":"annales-2018-dp-7","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Protein intake of 1.2 to 1, 4 g \/ kg \/ day","justification":""},{"idx":1,"correct":false,"proposition":"Fat intake at 40% of total energy intake","justification":"This ratio applies to the general population. It is lower in the athlete."},{"idx":2,"correct":true,"proposition":"Favor complex carbohydrates with a low glycemic index before the competition","justification":""},{"idx":3,"correct":true,"proposition":"Addition of NaCl to drinking water during exercise","justification":""},{"idx":4,"correct":false,"proposition":"Iron supplementation","justification":""}],"type":"dp"}
{"_id":"annales-2018-dp-7-qi-6","context":"You see a couple again in consultation due to primary infertility. They have been in a relationship for 8 years. Reports have been regular and unprotected for 18 months. There have been no pregnancies to date. Mrs. B. is 29 years old; She is Executive Secretary. She has a history of a mother with type 2 diabetes and a brother with type 1 diabetes. It weighs 60 kg for a height of 164 cm (BMI 22 kg\/m2). She does not take long-term treatment. It is G0P0. Its cycles are irregular, ranging from 35 to 65 days, without hot flashes. Mr. B., 32 years old, is a computer engineer. He has a history of allergic asthma and a bimalleolar fracture in adolescence following a skiing trauma. He is not currently taking any treatment. He practices triathlon in competition and trains an average of 10 hours per week (2 hours of indoor weight training, 3 hours of running, 1 hour of swimming and 4 hours of cycling on weekends). He does not smoke or consume alcohol very rarely. It weighs 64 kg for a height of 184 cm (BMI 18.9 kg\/m2). There is no notion of recent genital infection, nor of libido disorder. ","enonce":"The molecular analysis of Mr. B.'s spermogram will confirm the microdeletion in the AZFc region of the Y chromosome. With regard to Mrs B., she has just made, at your request, a temperature curve. This one shows anovulatory cycles. Which of the following dosages will you prescribe as a first-line treatment for this patient?","item":"annales-2018-dp-7","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Anti-Müllerian hormone","justification":""},{"idx":1,"correct":true,"proposition":"Estradiol","justification":""},{"idx":2,"correct":true,"proposition":"Prolactin","justification":""},{"idx":3,"correct":true,"proposition":"FSH","justification":""},{"idx":4,"correct":false,"proposition":"SHBG","justification":""}],"type":"dp"}
{"_id":"annales-2018-dp-7-qi-7","context":"You see a couple again in consultation due to primary infertility. They have been in a relationship for 8 years. Reports have been regular and unprotected for 18 months. There have been no pregnancies to date. Mrs. B. is 29 years old; She is Executive Secretary. She has a history of a mother with type 2 diabetes and a brother with type 1 diabetes. It weighs 60 kg for a height of 164 cm (BMI 22 kg\/m2). She does not take long-term treatment. It is G0P0. Its cycles are irregular, ranging from 35 to 65 days, without hot flashes. Mr. B., 32 years old, is a computer engineer. He has a history of allergic asthma and a bimalleolar fracture in adolescence following a skiing trauma. He is not currently taking any treatment. He practices triathlon in competition and trains an average of 10 hours per week (2 hours of indoor weight training, 3 hours of running, 1 hour of swimming and 4 hours of cycling on weekends). He does not smoke or consume alcohol very rarely. It weighs 64 kg for a height of 184 cm (BMI 18.9 kg\/m2). There is no notion of recent genital infection, nor of libido disorder. ","enonce":"Given the irregularity of the cycles, you mention the possibility of polycystic ovary syndrome. Among the following arguments, which would allow (would) bring this diagnosis to Mrs. 8. ? ","item":"annales-2018-dp-7","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Total testosterone at 0.7 ng\/ml (N: 0, 1-0.5)","justification":""},{"idx":1,"correct":false,"proposition":"FSH < 0.1 IU\/L (N: 2-8)","justification":""},{"idx":2,"correct":false,"proposition":"17-hydroxyprogesterone 18 ng\/ml (N: 0.2-2)","justification":""},{"idx":3,"correct":false,"proposition":"Ovarian volume assessed at 5 ml on pelvic ultrasound","justification":""},{"idx":4,"correct":true,"proposition":"More than 19 follicles per ovary on pelvic ultrasound","justification":"Beware of new PCOS recommendations"}],"type":"dp"}
{"_id":"annales-2018-dp-7-qi-8","context":"You see a couple again in consultation due to primary infertility. They have been in a relationship for 8 years. Reports have been regular and unprotected for 18 months. There have been no pregnancies to date. Mrs. B. is 29 years old; She is Executive Secretary. She has a history of a mother with type 2 diabetes and a brother with type 1 diabetes. It weighs 60 kg for a height of 164 cm (BMI 22 kg\/m2). She does not take long-term treatment. It is G0P0. Its cycles are irregular, ranging from 35 to 65 days, without hot flashes. Mr. B., 32 years old, is a computer engineer. He has a history of allergic asthma and a bimalleolar fracture in adolescence following a skiing trauma. He is not currently taking any treatment. He practices triathlon in competition and trains an average of 10 hours per week (2 hours of indoor weight training, 3 hours of running, 1 hour of swimming and 4 hours of cycling on weekends). He does not smoke or consume alcohol very rarely. It weighs 64 kg for a height of 184 cm (BMI 18.9 kg\/m2). There is no notion of recent genital infection, nor of libido disorder. ","enonce":"While waiting for the results of the ovarian ultrasound, Mrs. B, worried, calls you to communicate the results of the biological assessment that you prescribed: estradiol 35 pg \/ ml (N: 20-70), testosterone 0.89 ng \/ ml (N: 0, 1 - 0.5), LH at 11.4IU \/ L (N: 2- 6), FSH at 4.8 IU \/ L (N: 2- 8), prolactin at 15μg \/ L (N<20). Which of the following clinical situations can (can) give this clinical-biological picture? ","item":"annales-2018-dp-7","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Anorexia nervosa","justification":""},{"idx":1,"correct":false,"proposition":"Early ovarian failure","justification":""},{"idx":2,"correct":true,"proposition":"Polycystic ovary syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Prolactin adenoma","justification":""},{"idx":4,"correct":false,"proposition":"Hypercortisolism","justification":""}],"type":"dp"}
{"_id":"annales-2018-dp-7-qi-9","context":"You see a couple again in consultation due to primary infertility. They have been in a relationship for 8 years. Reports have been regular and unprotected for 18 months. There have been no pregnancies to date. Mrs. B. is 29 years old; She is Executive Secretary. She has a history of a mother with type 2 diabetes and a brother with type 1 diabetes. It weighs 60 kg for a height of 164 cm (BMI 22 kg\/m2). She does not take long-term treatment. It is G0P0. Its cycles are irregular, ranging from 35 to 65 days, without hot flashes. Mr. B., 32 years old, is a computer engineer. He has a history of allergic asthma and a bimalleolar fracture in adolescence following a skiing trauma. He is not currently taking any treatment. He practices triathlon in competition and trains an average of 10 hours per week (2 hours of indoor weight training, 3 hours of running, 1 hour of swimming and 4 hours of cycling on weekends). He does not smoke or consume alcohol very rarely. It weighs 64 kg for a height of 184 cm (BMI 18.9 kg\/m2). There is no notion of recent genital infection, nor of libido disorder. ","enonce":"You will recover the pelvic ultrasound whose result is compatible with the diagnosis of polycystic ovary syndrome. You therefore refer the couple to a medically assisted procreation center given the diagnosis of microdeletion of the Y chromosome in Mr. and polycystic ovary syndrome in Mrs. Nevertheless, you remind Mrs. B beforehand that she is at risk of developing gestational diabetes. Which of the criteria below makes you make this statement? ","item":"annales-2018-dp-7","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"The age of the patient","justification":""},{"idx":1,"correct":false,"proposition":"The patient's weight","justification":""},{"idx":2,"correct":true,"proposition":"Maternal history of diabetes","justification":""},{"idx":3,"correct":true,"proposition":"Polycystic ovary syndrome","justification":""},{"idx":4,"correct":false,"proposition":"The context of medically assisted reproduction care","justification":""}],"type":"dp"}
{"_id":"annales-2018-dp-7-qi-10","context":"You see a couple again in consultation due to primary infertility. They have been in a relationship for 8 years. Reports have been regular and unprotected for 18 months. There have been no pregnancies to date. Mrs. B. is 29 years old; She is Executive Secretary. She has a history of a mother with type 2 diabetes and a brother with type 1 diabetes. It weighs 60 kg for a height of 164 cm (BMI 22 kg\/m2). She does not take long-term treatment. It is G0P0. Its cycles are irregular, ranging from 35 to 65 days, without hot flashes. Mr. B., 32 years old, is a computer engineer. He has a history of allergic asthma and a bimalleolar fracture in adolescence following a skiing trauma. He is not currently taking any treatment. He practices triathlon in competition and trains an average of 10 hours per week (2 hours of indoor weight training, 3 hours of running, 1 hour of swimming and 4 hours of cycling on weekends). He does not smoke or consume alcohol very rarely. It weighs 64 kg for a height of 184 cm (BMI 18.9 kg\/m2). There is no notion of recent genital infection, nor of libido disorder. ","enonce":"Four years later, after two pregnancies obtained by in vitro fertilization, Mrs. B. returns to your consultation due to unusual asthenia. She had first put this on the account of the care of her 2 young children and on the resumption of her professional activity. She thinks she has hypothyroidism like her aunt and paternal grandmother. Which of the following signs is compatible with the diagnosis of hypothyroidism? ","item":"annales-2018-dp-7","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Myalgia","justification":""},{"idx":1,"correct":true,"proposition":"Oligomenorrhea","justification":""},{"idx":2,"correct":true,"proposition":"Carpal tunnel syndrome","justification":""},{"idx":3,"correct":true,"proposition":"Hearing loss","justification":""},{"idx":4,"correct":false,"proposition":"Acne","justification":""}],"type":"dp"}
{"_id":"annales-2018-dp-7-qi-11","context":"You see a couple again in consultation due to primary infertility. They have been in a relationship for 8 years. Reports have been regular and unprotected for 18 months. There have been no pregnancies to date. Mrs. B. is 29 years old; She is Executive Secretary. She has a history of a mother with type 2 diabetes and a brother with type 1 diabetes. It weighs 60 kg for a height of 164 cm (BMI 22 kg\/m2). She does not take long-term treatment. It is G0P0. Its cycles are irregular, ranging from 35 to 65 days, without hot flashes. Mr. B., 32 years old, is a computer engineer. He has a history of allergic asthma and a bimalleolar fracture in adolescence following a skiing trauma. He is not currently taking any treatment. He practices triathlon in competition and trains an average of 10 hours per week (2 hours of indoor weight training, 3 hours of running, 1 hour of swimming and 4 hours of cycling on weekends). He does not smoke or consume alcohol very rarely. It weighs 64 kg for a height of 184 cm (BMI 18.9 kg\/m2). There is no notion of recent genital infection, nor of libido disorder. ","enonce":"Which of the following bioassay will you prescribe as a first-line treatment? ","item":"annales-2018-dp-7","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"T3 free","justification":""},{"idx":1,"correct":false,"proposition":"T4 free","justification":""},{"idx":2,"correct":true,"proposition":"TSH","justification":""},{"idx":3,"correct":false,"proposition":"Thyroglobulin","justification":""},{"idx":4,"correct":false,"proposition":"Anti-thyroperoxidase antibodies","justification":""}],"type":"dp"}
{"_id":"annales-2018-dp-7-qi-12","context":"You see a couple again in consultation due to primary infertility. They have been in a relationship for 8 years. Reports have been regular and unprotected for 18 months. There have been no pregnancies to date. Mrs. B. is 29 years old; She is Executive Secretary. She has a history of a mother with type 2 diabetes and a brother with type 1 diabetes. It weighs 60 kg for a height of 164 cm (BMI 22 kg\/m2). She does not take long-term treatment. It is G0P0. Its cycles are irregular, ranging from 35 to 65 days, without hot flashes. Mr. B., 32 years old, is a computer engineer. He has a history of allergic asthma and a bimalleolar fracture in adolescence following a skiing trauma. He is not currently taking any treatment. He practices triathlon in competition and trains an average of 10 hours per week (2 hours of indoor weight training, 3 hours of running, 1 hour of swimming and 4 hours of cycling on weekends). He does not smoke or consume alcohol very rarely. It weighs 64 kg for a height of 184 cm (BMI 18.9 kg\/m2). There is no notion of recent genital infection, nor of libido disorder. ","enonce":"The TSH result is given by the laboratory: 52 mUl\/l (N: 0.4 - 4). Which of the following exams do you prescribe now?","item":"annales-2018-dp-7","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Anti-thyroglobulin antibodies","justification":""},{"idx":1,"correct":true,"proposition":"Anti-thyroperoxidase antibodies","justification":""},{"idx":2,"correct":false,"proposition":"Anti-TSH receptor antibodies","justification":""},{"idx":3,"correct":false,"proposition":"T3 free"},{"idx":4,"correct":false,"proposition":"Thyroid scintigraphy"}],"type":"dp"}
{"_id":"annales-2018-dp-7-qi-13","context":"You see a couple again in consultation due to primary infertility. They have been in a relationship for 8 years. Reports have been regular and unprotected for 18 months. There have been no pregnancies to date. Mrs. B. is 29 years old; She is Executive Secretary. She has a history of a mother with type 2 diabetes and a brother with type 1 diabetes. It weighs 60 kg for a height of 164 cm (BMI 22 kg\/m2). She does not take long-term treatment. It is G0P0. Its cycles are irregular, ranging from 35 to 65 days, without hot flashes. Mr. B., 32 years old, is a computer engineer. He has a history of allergic asthma and a bimalleolar fracture in adolescence following a skiing trauma. He is not currently taking any treatment. He practices triathlon in competition and trains an average of 10 hours per week (2 hours of indoor weight training, 3 hours of running, 1 hour of swimming and 4 hours of cycling on weekends). He does not smoke or consume alcohol very rarely. It weighs 64 kg for a height of 184 cm (BMI 18.9 kg\/m2). There is no notion of recent genital infection, nor of libido disorder. ","enonce":"The assay of anti-thyropxydase antibodies is positive and ultrasound confirms the existence of a goiter compatible with autoimmune thyroiditis with the presence of a left para-isthmian nodular image. Which of the following ultrasound signs is (are) in favor of the benignity of a thyroid nodule?","item":"annales-2018-dp-7","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":" Cystic nature","justification":""},{"idx":1,"correct":false,"proposition":"Incomplete halo","justification":""},{"idx":2,"correct":true,"proposition":"Lack of vascularization","justification":""},{"idx":3,"correct":false,"proposition":"Hypoechogenicity","justification":""},{"idx":4,"correct":true,"proposition":"Multiplicity of nodules","justification":""}],"type":"dp"}
{"_id":"annales-2018-dp-7-qi-14","context":"You see a couple again in consultation due to primary infertility. They have been in a relationship for 8 years. Reports have been regular and unprotected for 18 months. There have been no pregnancies to date. Mrs. B. is 29 years old; She is Executive Secretary. She has a history of a mother with type 2 diabetes and a brother with type 1 diabetes. It weighs 60 kg for a height of 164 cm (BMI 22 kg\/m2). She does not take long-term treatment. It is G0P0. Its cycles are irregular, ranging from 35 to 65 days, without hot flashes. Mr. B., 32 years old, is a computer engineer. He has a history of allergic asthma and a bimalleolar fracture in adolescence following a skiing trauma. He is not currently taking any treatment. He practices triathlon in competition and trains an average of 10 hours per week (2 hours of indoor weight training, 3 hours of running, 1 hour of swimming and 4 hours of cycling on weekends). He does not smoke or consume alcohol very rarely. It weighs 64 kg for a height of 184 cm (BMI 18.9 kg\/m2). There is no notion of recent genital infection, nor of libido disorder. ","enonce":"It is actually a T1RADS 1 cystic nodule, completely benign in appearance. Due to clinical and biological hypothyroidism, you decide to start treatment with levothyroxine. The patient stops you while you are writing your prescription because of the side effects reported recently in the media and possibly related to the molecule. You have read a study on this subject, of which here is an excerpt: << In order to highlight a potential role of the new formulation of levothyroxine, we compared, by consulting the medical records of three centers specialized in thyroidology, the side effects reported by hypothyroid patients treated with levothyroxine old formula (FA; n = 1500) or levothyroxine new formula (NF; n = 1800) over a period of 4 months concomitant with the mediatization. 295 patients reported an adverse event in the NF group and 153 in the FA group. Which of the following proposals for this study is accurate? ","item":"annales-2018-dp-7","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"This is a randomized study","justification":""},{"idx":1,"correct":false,"proposition":"This is a case-control study","justification":""},{"idx":2,"correct":true,"proposition":"There is a possible selection bias","justification":""},{"idx":3,"correct":false,"proposition":"Relative risk is 295\/153","justification":""},{"idx":4,"correct":false,"proposition":"The confidence interval for relative risk is +\/- 1,800\/1,500","justification":""}],"type":"dp"}
{"_id":"annales-2019-dp-2-qi-1","context":"You see in consultation in September a 19-year-old patient for respiratory discomfort such as wheezing sensations and chest tightness. She has been smoking 10 cigarettes a day for 3 years. It has no other particular antecedent. She is a student at the School of Fine Arts and passionate about wood carving, an activity she only does during the week and which she will make her job. At the interrogation, there are no other particular symptoms. She has no fever and the clinical examination when you see her is strictly normal. She says she is very often woken up at night by these unpleasant or even distressing sensations. Her symptoms have appeared since she lives in her student apartment and left her childhood home. This is a small apartment in a rather dilapidated accommodation. She took her cat to this new home. She has this cat for 5 years while she was still living with these parents but contact with the cat had never been a problem for her until then. She has no other animals. She presents you with a chest x-ray taken 3 days ago.","enonce":"Based on the data you have at the moment, what is the correct answer(s)?","item":"annales-2019-dp-2","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"It is very surprising that pulmonary auscultation is really normal.","justification":"Clinical examination is normal in asthma apart from attacks. It is a paroxysmal pathology, with brief symptoms (less than twenty minutes)."},{"idx":1,"correct":false,"proposition":"You start oral corticosteroid therapy of 0.5 mg \/ kg for 15 days.","justification":"No treatment if no diagnosis"},{"idx":2,"correct":false,"proposition":"You prescribe a chest CT scan.","justification":"Useless at this point"},{"idx":3,"correct":true,"proposition":"You suspect at the interrogation an allergic asthma.","justification":""},{"idx":4,"correct":false,"proposition":"She necessarily smokes a lot more than she admits.","justification":"We are not in Dr. House, at EDN we must believe the patients;) (except for very good reason to do the opposite)"}],"type":"dp"}
{"_id":"annales-2019-dp-2-qi-2","context":"You see in consultation in September a 19-year-old patient for respiratory discomfort such as wheezing sensations and chest tightness. She has been smoking 10 cigarettes a day for 3 years. It has no other particular antecedent. She is a student at the School of Fine Arts and passionate about wood carving, an activity she only does during the week and which she will make her job. At the interrogation, there are no other particular symptoms. She has no fever and the clinical examination when you see her is strictly normal. She says she is very often woken up at night by these unpleasant or even distressing sensations. Her symptoms have appeared since she lives in her student apartment and left her childhood home. This is a small apartment in a rather dilapidated accommodation. She took her cat to this new home. She has this cat for 5 years while she was still living with these parents but contact with the cat had never been a problem for her until then. She has no other animals. She presents you with a chest x-ray taken 3 days ago.","enonce":"For this young patient, what additional tests do you offer?","item":"annales-2019-dp-2","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Bronchial fibroscopy","justification":""},{"idx":1,"correct":false,"proposition":"Arterial gasometry","justification":""},{"idx":2,"correct":true,"proposition":"Conducting prick-tests","justification":"Achievable from 3 years. A chest x-ray (which is normal in asthma) is also done."},{"idx":3,"correct":true,"proposition":"EFR","justification":"Achievable from 6 years old"},{"idx":4,"correct":false,"proposition":"esophageal pH","justification":""}],"type":"dp"}
{"_id":"annales-2019-dp-2-qi-3","context":"You see in consultation in September a 19-year-old patient for respiratory discomfort such as wheezing sensations and chest tightness. She has been smoking 10 cigarettes a day for 3 years. It has no other particular antecedent. She is a student at the School of Fine Arts and passionate about wood carving, an activity she only does during the week and which she will make her job. At the interrogation, there are no other particular symptoms. She has no fever and the clinical examination when you see her is strictly normal. She says she is very often woken up at night by these unpleasant or even distressing sensations. Her symptoms have appeared since she lives in her student apartment and left her childhood home. This is a small apartment in a rather dilapidated accommodation. She took her cat to this new home. She has this cat for 5 years while she was still living with these parents but contact with the cat had never been a problem for her until then. She has no other animals. She presents you with a chest x-ray taken 3 days ago.","enonce":"You realize a volume flow loop. The green square and the red triangle correspond to the volumes obtained after the first second of expiration. Which propositions are true? Give the correct answer(s).","item":"annales-2019-dp-2","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Point A is the volume corresponding to the forced vital capacity","justification":"The upper curve is expiratory."},{"idx":1,"correct":true,"proposition":"Point B (triangle) represents post-bronchodilator FEV1","justification":"This is the volume that the patient exhales after one second."},{"idx":2,"correct":false,"proposition":"The blue curve represents the pre-bronchodilator inspiratory flow","justification":"Expiratory flow (because it is the exhalation at the top, and the inspiration at the bottom, by convention)."},{"idx":3,"correct":false,"proposition":"Point D corresponds to the functional residual capacity","justification":"This is the peak inspiratory flow."},{"idx":4,"correct":false,"proposition":"Point E is total lung capacity","justification":"This is the peak expiratory flow. The colors are not very legible, we grant you. This is unfortunately the official image of the cng."}],"type":"dp"}
{"_id":"annales-2019-dp-2-qi-4","context":"You see in consultation in September a 19-year-old patient for respiratory discomfort such as wheezing sensations and chest tightness. She has been smoking 10 cigarettes a day for 3 years. It has no other particular antecedent. She is a student at the School of Fine Arts and passionate about wood carving, an activity she only does during the week and which she will make her job. At the interrogation, there are no other particular symptoms. She has no fever and the clinical examination when you see her is strictly normal. She says she is very often woken up at night by these unpleasant or even distressing sensations. Her symptoms have appeared since she lives in her student apartment and left her childhood home. This is a small apartment in a rather dilapidated accommodation. She took her cat to this new home. She has this cat for 5 years while she was still living with these parents but contact with the cat had never been a problem for her until then. She has no other animals. She presents you with a chest x-ray taken 3 days ago.","enonce":"Attached are the numerical results of the flow-volume loop. Regarding the results presented in the table above, which is (are) the exact proposition(s)?","item":"annales-2019-dp-2","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"There is an obstructive ventilatory disorder of significant reversibility","justification":"FEV1 increases by 200 mL and more than 12%"},{"idx":1,"correct":false,"proposition":"Reduction in FEV1 at baseline is not significant","justification":""},{"idx":2,"correct":true,"proposition":"Peak expiratory flow is impaired","justification":"It's 53%, it's not tip top 😬"},{"idx":3,"correct":false,"proposition":"There is a restrictive respiratory disorder (RVC)","justification":""},{"idx":4,"correct":true,"proposition":"There is an obstructive breathing disorder (ORT)","justification":""}],"type":"dp"}
{"_id":"annales-2019-dp-2-qi-5","context":"You see in consultation in September a 19-year-old patient for respiratory discomfort such as wheezing sensations and chest tightness. She has been smoking 10 cigarettes a day for 3 years. It has no other particular antecedent. She is a student at the School of Fine Arts and passionate about wood carving, an activity she only does during the week and which she will make her job. At the interrogation, there are no other particular symptoms. She has no fever and the clinical examination when you see her is strictly normal. She says she is very often woken up at night by these unpleasant or even distressing sensations. Her symptoms have appeared since she lives in her student apartment and left her childhood home. This is a small apartment in a rather dilapidated accommodation. She took her cat to this new home. She has this cat for 5 years while she was still living with these parents but contact with the cat had never been a problem for her until then. She has no other animals. She presents you with a chest x-ray taken 3 days ago.","enonce":"The diagnosis is clearly asthma and most likely allergic asthma. What allergens could most likely be responsible for this asthma when you see it? Give the correct answer(s). ","item":"annales-2019-dp-2","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Mites","justification":""},{"idx":1,"correct":true,"proposition":"Cockroaches","justification":""},{"idx":2,"correct":true,"proposition":"Cat","justification":"His cat did not cause him problems before but that can change 😉."},{"idx":3,"correct":false,"proposition":"Dog","justification":"There was no contact reported by the patient."},{"idx":4,"correct":false,"proposition":"Grass pollen","justification":"This is not the period."}],"type":"dp"}
{"_id":"annales-2019-dp-2-qi-6","context":"You see in consultation in September a 19-year-old patient for respiratory discomfort such as wheezing sensations and chest tightness. She has been smoking 10 cigarettes a day for 3 years. It has no other particular antecedent. She is a student at the School of Fine Arts and passionate about wood carving, an activity she only does during the week and which she will make her job. At the interrogation, there are no other particular symptoms. She has no fever and the clinical examination when you see her is strictly normal. She says she is very often woken up at night by these unpleasant or even distressing sensations. Her symptoms have appeared since she lives in her student apartment and left her childhood home. This is a small apartment in a rather dilapidated accommodation. She took her cat to this new home. She has this cat for 5 years while she was still living with these parents but contact with the cat had never been a problem for her until then. She has no other animals. She presents you with a chest x-ray taken 3 days ago.","enonce":"The apartment is dilapidated but there are no cockroaches. To advance in allergy diagnosis, you want to perform prick-tests. Regarding these tests, give the answer(s) that you think is accurate?","item":"annales-2019-dp-2","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"They explore immediate IgE-mediated sensitivity","justification":""},{"idx":1,"correct":false,"proposition":"They should be accompanied by patch tests in order to increase the specificity of the result","justification":""},{"idx":2,"correct":false,"proposition":"They will have to be performed when asthma is controlled.","justification":""},{"idx":3,"correct":false,"proposition":"They will have to be carried out in a hospital environment close to intensive care","justification":""},{"idx":4,"correct":false,"proposition":"They can be performed once the patient has taken an antihistamine for 5 consecutive days.","justification":""}],"type":"dp"}
{"_id":"annales-2019-dp-2-qi-7","context":"You see in consultation in September a 19-year-old patient for respiratory discomfort such as wheezing sensations and chest tightness. She has been smoking 10 cigarettes a day for 3 years. It has no other particular antecedent. She is a student at the School of Fine Arts and passionate about wood carving, an activity she only does during the week and which she will make her job. At the interrogation, there are no other particular symptoms. She has no fever and the clinical examination when you see her is strictly normal. She says she is very often woken up at night by these unpleasant or even distressing sensations. Her symptoms have appeared since she lives in her student apartment and left her childhood home. This is a small apartment in a rather dilapidated accommodation. She took her cat to this new home. She has this cat for 5 years while she was still living with these parents but contact with the cat had never been a problem for her until then. She has no other animals. She presents you with a chest x-ray taken 3 days ago.","enonce":"Regarding the technique of prick-tests, give the exact answer(s).","item":"annales-2019-dp-2","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"The goal is to put the antigens in contact with the epidermis","justification":""},{"idx":1,"correct":true,"proposition":"Purified and standardized extracts of the most common allergens are used.","justification":""},{"idx":2,"correct":true,"proposition":"Always make a negative control and take into account the diameter of the papule of it when there is one","justification":""},{"idx":3,"correct":true,"proposition":"The reading of the tests is done at 15 min","justification":"Unlike patch tests, which are read several days later."},{"idx":4,"correct":false,"proposition":"A test is considered positive if the diameter of the papule is greater than or equal to that of the negative control","justification":""}],"type":"dp"}
{"_id":"annales-2019-dp-2-qi-8","context":"You see in consultation in September a 19-year-old patient for respiratory discomfort such as wheezing sensations and chest tightness. She has been smoking 10 cigarettes a day for 3 years. It has no other particular antecedent. She is a student at the School of Fine Arts and passionate about wood carving, an activity she only does during the week and which she will make her job. At the interrogation, there are no other particular symptoms. She has no fever and the clinical examination when you see her is strictly normal. She says she is very often woken up at night by these unpleasant or even distressing sensations. Her symptoms have appeared since she lives in her student apartment and left her childhood home. This is a small apartment in a rather dilapidated accommodation. She took her cat to this new home. She has this cat for 5 years while she was still living with these parents but contact with the cat had never been a problem for her until then. She has no other animals. She presents you with a chest x-ray taken 3 days ago.","enonce":"Here is a photograph of his right forearm on which the prick-tests were carried out 15 minutes before. Other allergens have been tested on the other forearm and are all negative including other tree pollens. What can you deduce from the result of these prick-tests. Give the correct answer(s).","item":"annales-2019-dp-2","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Tests should be interpreted with caution due to significant redness","justification":"We do not interpret redness, we interpret induration."},{"idx":1,"correct":true,"proposition":"The patient is sensitized or allergic to dust mites","justification":""},{"idx":2,"correct":true,"proposition":"Tests could explain the presence of seasonal rhinitis","justification":"The patient is allergic to grass pollen."},{"idx":3,"correct":true,"proposition":"The patient is not a priori allergic to the cat","justification":""},{"idx":4,"correct":false,"proposition":"The patient should avoid dogs","justification":""}],"type":"dp"}
{"_id":"annales-2019-dp-2-qi-9","context":"You see in consultation in September a 19-year-old patient for respiratory discomfort such as wheezing sensations and chest tightness. She has been smoking 10 cigarettes a day for 3 years. It has no other particular antecedent. She is a student at the School of Fine Arts and passionate about wood carving, an activity she only does during the week and which she will make her job. At the interrogation, there are no other particular symptoms. She has no fever and the clinical examination when you see her is strictly normal. She says she is very often woken up at night by these unpleasant or even distressing sensations. Her symptoms have appeared since she lives in her student apartment and left her childhood home. This is a small apartment in a rather dilapidated accommodation. She took her cat to this new home. She has this cat for 5 years while she was still living with these parents but contact with the cat had never been a problem for her until then. She has no other animals. She presents you with a chest x-ray taken 3 days ago.","enonce":"The patient asks you the question of the responsibility of her sculpting activity in the genesis of her symptoms. Give the correct answer(s).","item":"annales-2019-dp-2","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Look for decreases in peak expiratory flow or FEV1 correlated with work","justification":""},{"idx":1,"correct":true,"proposition":"It is necessary to look for an improvement of the symptoms on weekends and their disappearance during periods of leave","justification":""},{"idx":2,"correct":false,"proposition":"The presence of nocturnal symptoms makes it possible to eliminate an occupational origin","justification":""},{"idx":3,"correct":false,"proposition":"The fact that the patient is already sensitized to other allergens eliminates this diagnosis","justification":""},{"idx":4,"correct":false,"proposition":"Woodworking is not one of the occupations at risk of occupational allergy","justification":""}],"type":"dp"}
{"_id":"annales-2019-dp-2-qi-10","context":"You see in consultation in September a 19-year-old patient for respiratory discomfort such as wheezing sensations and chest tightness. She has been smoking 10 cigarettes a day for 3 years. It has no other particular antecedent. She is a student at the School of Fine Arts and passionate about wood carving, an activity she only does during the week and which she will make her job. At the interrogation, there are no other particular symptoms. She has no fever and the clinical examination when you see her is strictly normal. She says she is very often woken up at night by these unpleasant or even distressing sensations. Her symptoms have appeared since she lives in her student apartment and left her childhood home. This is a small apartment in a rather dilapidated accommodation. She took her cat to this new home. She has this cat for 5 years while she was still living with these parents but contact with the cat had never been a problem for her until then. She has no other animals. She presents you with a chest x-ray taken 3 days ago.","enonce":"You find no temporal link between his work on wood and the appearance of symptoms. The patient says, however, that every time she sleeps in older bedding at her grandmother's house, she is terribly embarrassed about breathing with the occurrence of nasal obstruction. There are no animals in his grandmother's house. She also knows that when she shakes a carpet she will sneeze and her nose will run. The clinical history and results of EFRs and prick tests allow you to retain the diagnosis of asthma allergic to dust mites. What therapeutic strategies will you put in place immediately in this young patient besides quitting smoking? Give the correct answer(s).","item":"annales-2019-dp-2","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Work stoppage","justification":""},{"idx":1,"correct":true,"proposition":"Tips for avoiding mites","justification":""},{"idx":2,"correct":false,"proposition":"Allergenic (specific) immunotherapy for dust mites","justification":""},{"idx":3,"correct":false,"proposition":"Treatment of gastroesophageal reflux disease in principle","justification":""},{"idx":4,"correct":true,"proposition":"Inhaled treatment of his asthma","justification":""}],"type":"dp"}
{"_id":"annales-2019-dp-2-qi-11","context":"You see in consultation in September a 19-year-old patient for respiratory discomfort such as wheezing sensations and chest tightness. She has been smoking 10 cigarettes a day for 3 years. It has no other particular antecedent. She is a student at the School of Fine Arts and passionate about wood carving, an activity she only does during the week and which she will make her job. At the interrogation, there are no other particular symptoms. She has no fever and the clinical examination when you see her is strictly normal. She says she is very often woken up at night by these unpleasant or even distressing sensations. Her symptoms have appeared since she lives in her student apartment and left her childhood home. This is a small apartment in a rather dilapidated accommodation. She took her cat to this new home. She has this cat for 5 years while she was still living with these parents but contact with the cat had never been a problem for her until then. She has no other animals. She presents you with a chest x-ray taken 3 days ago.","enonce":"Treatment for asthma is needed. What do you prescribe to him? Give the correct answer(s). ","item":"annales-2019-dp-2","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"An antihistamine","justification":""},{"idx":1,"correct":true,"proposition":"Inhaled corticosteroid","justification":""},{"idx":2,"correct":false,"proposition":"A nebulizer to make bronchodilator aerosols at home","justification":""},{"idx":3,"correct":true,"proposition":"A rescue treatment based on short-acting B2-mimetics (BDCA) in spray or dry powder","justification":"Every asthmatic must have his rescue treatment."},{"idx":4,"correct":true,"proposition":"Long-acting B2-mimetic (BDLA) may be immediately combined with low-dose inhaled corticosteroid","justification":"The diagnosis of asthma can lead to a direct prescription of level three (BDLA + Low dose inhaled corticosteroids) depending on the severity of the initial symptoms."}],"type":"dp"}
{"_id":"annales-2019-dp-2-qi-12","context":"You see in consultation in September a 19-year-old patient for respiratory discomfort such as wheezing sensations and chest tightness. She has been smoking 10 cigarettes a day for 3 years. It has no other particular antecedent. She is a student at the School of Fine Arts and passionate about wood carving, an activity she only does during the week and which she will make her job. At the interrogation, there are no other particular symptoms. She has no fever and the clinical examination when you see her is strictly normal. She says she is very often woken up at night by these unpleasant or even distressing sensations. Her symptoms have appeared since she lives in her student apartment and left her childhood home. This is a small apartment in a rather dilapidated accommodation. She took her cat to this new home. She has this cat for 5 years while she was still living with these parents but contact with the cat had never been a problem for her until then. She has no other animals. She presents you with a chest x-ray taken 3 days ago.","enonce":"Regarding inhaled corticosteroids, what are the classic side effects? Give the correct answer(s).","item":"annales-2019-dp-2","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Cramps","justification":""},{"idx":1,"correct":true,"proposition":"Dysphonia","justification":""},{"idx":2,"correct":true,"proposition":"Oral pharyngeal mycosis","justification":""},{"idx":3,"correct":false,"proposition":"Tremors","justification":""},{"idx":4,"correct":false,"proposition":"Peptic ulcer","justification":""}],"type":"dp"}
{"_id":"annales-2019-dp-2-qi-13","context":"You see in consultation in September a 19-year-old patient for respiratory discomfort such as wheezing sensations and chest tightness. She has been smoking 10 cigarettes a day for 3 years. It has no other particular antecedent. She is a student at the School of Fine Arts and passionate about wood carving, an activity she only does during the week and which she will make her job. At the interrogation, there are no other particular symptoms. She has no fever and the clinical examination when you see her is strictly normal. She says she is very often woken up at night by these unpleasant or even distressing sensations. Her symptoms have appeared since she lives in her student apartment and left her childhood home. This is a small apartment in a rather dilapidated accommodation. She took her cat to this new home. She has this cat for 5 years while she was still living with these parents but contact with the cat had never been a problem for her until then. She has no other animals. She presents you with a chest x-ray taken 3 days ago.","enonce":"To prevent the side effects of inhaled corticosteroids, you explain to the patient that it is essential to rinse her mouth thoroughly after each dose. You stress the importance of quitting smoking. You will also explain at length the interest of the eviction of dust mites and you will give the necessary advice to reduce as much as possible the allergenic load of mites at home. Which of the tips are right for this purpose? Give the correct answer(s). ","item":"annales-2019-dp-2","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Use of a vacuum cleaner with HEPA filter (High Efficiency for Airborne Particles)","justification":""},{"idx":1,"correct":true,"proposition":"Anti-dust mite covers for mattresses, duvets and pillows","justification":""},{"idx":2,"correct":true,"proposition":"Regular washing of sheets at high temperature (60 °C)","justification":""},{"idx":3,"correct":true,"proposition":"Reduction of indoor relative humidity","justification":""},{"idx":4,"correct":false,"proposition":"Getting rid of synthetic pillows","justification":"On the contrary, they must be given priority."}],"type":"dp"}
{"_id":"annales-2019-dp-2-qi-14","context":"You see in consultation in September a 19-year-old patient for respiratory discomfort such as wheezing sensations and chest tightness. She has been smoking 10 cigarettes a day for 3 years. It has no other particular antecedent. She is a student at the School of Fine Arts and passionate about wood carving, an activity she only does during the week and which she will make her job. At the interrogation, there are no other particular symptoms. She has no fever and the clinical examination when you see her is strictly normal. She says she is very often woken up at night by these unpleasant or even distressing sensations. Her symptoms have appeared since she lives in her student apartment and left her childhood home. This is a small apartment in a rather dilapidated accommodation. She took her cat to this new home. She has this cat for 5 years while she was still living with these parents but contact with the cat had never been a problem for her until then. She has no other animals. She presents you with a chest x-ray taken 3 days ago.","enonce":"You see her again 3 months later. She obviously takes her inhaled treatment very well and conscientiously morning and evening. She quit smoking. She tells you frankly better. His auscultation is always normal. Its volume flow loop is improved. His FEV1 is spontaneously 82% theoretical. There is complete reversibility with an improvement in FEV1 of 13% and 450 ml. Which of the following proposals make it possible to evaluate the quality of asthma control? Give the correct answer(s).","item":"annales-2019-dp-2","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Smoking cessation","justification":""},{"idx":1,"correct":false,"proposition":"The proper implementation of mite eviction advice","justification":""},{"idx":2,"correct":true,"proposition":"Salbutamol consumption","justification":"Asthma controlled if: symptoms are controlled (via the 5 questions of the ACT), exacerbations are rare, there is no TVO (FEV> 80%)."},{"idx":3,"correct":false,"proposition":"The fact that she says she is frankly better","justification":""},{"idx":4,"correct":true,"proposition":"Number of nocturnal asthma-related symptoms per week","justification":""}],"type":"dp"}
{"_id":"annales-2019-dp-2-qi-15","context":"You see in consultation in September a 19-year-old patient for respiratory discomfort such as wheezing sensations and chest tightness. She has been smoking 10 cigarettes a day for 3 years. It has no other particular antecedent. She is a student at the School of Fine Arts and passionate about wood carving, an activity she only does during the week and which she will make her job. At the interrogation, there are no other particular symptoms. She has no fever and the clinical examination when you see her is strictly normal. She says she is very often woken up at night by these unpleasant or even distressing sensations. Her symptoms have appeared since she lives in her student apartment and left her childhood home. This is a small apartment in a rather dilapidated accommodation. She took her cat to this new home. She has this cat for 5 years while she was still living with these parents but contact with the cat had never been a problem for her until then. She has no other animals. She presents you with a chest x-ray taken 3 days ago.","enonce":"Asthma remains poorly controlled despite the increase in inhaled corticosteroid therapy. She wakes up at night. Allergen immunotherapy is put in place and his symptoms of perennial allergic rhinitis will frankly regress or even disappear. You will be able to reduce his inhaled corticosteroid therapy. 4 years later, she comes back to see you for a very disabling rhinitis occurring in the spring during her exam periods. His nose is stuffy. It flows a lot. She no longer smells smells. Her eyes are itchy and scratchy. She had already had the same symptoms last year. The symptoms lasted two months and then subsided. You suspect grass pollinosis. His asthma is not aggravated. What attitude(s) do you recommend? Give the correct answer(s).","item":"annales-2019-dp-2","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"You prescribe antihistamines anti-H1","justification":""},{"idx":1,"correct":false,"proposition":"You ask him to go out until late at night","justification":"Your patient is not batman eh 😂"},{"idx":2,"correct":true,"proposition":"You can prescribe a nasal corticosteroid","justification":"They are indicated in case of nasal obstruction. It is necessary to respect contraindications, and especially non-indications."},{"idx":3,"correct":true,"proposition":"You advise him daily nose washes with saline","justification":""},{"idx":4,"correct":true,"proposition":"You can prescribe cromones","justification":"According to Wikipedia: 'Sodium cromoglicate is a compound used as a mast cell stabilizer in allergic rhinitis, asthma and allergic conjunctivitis.'"}],"type":"dp"}
{"_id":"annales-2019-dp-4-qi-1","context":"A 76-year-old man consults for a bullous rash that appeared for a few days. He has been treated for heart failure for 13 years with beta-blocker (bisoprolol) and a combination of an angiotensin receptor type 2 antagonist and a diuretic (valsartan, hydrochlorothiazide). He also has type 2 diabetes treated with diet and metformin. He lives with his disabled wife. He complains of pruritus and dry skin for about 8 months. The clinical examination reveals bubbles in the trunk and upper limbs (Photo). Examination of the mucous membranes is normal. It presents an average of 30 new bubbles per day. He has been applying for several weeks a topical corticosteroid of moderate activity (desonide) associated with a dose of 25 mg of hydroxyzine (anti-histamine) at bedtime. ","enonce":"Which semiological element(s) do you identify in the photo? ","item":"annales-2019-dp-4","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Urticarian cupboards","justification":""},{"idx":1,"correct":true,"proposition":"Vesicles","justification":""},{"idx":2,"correct":true,"proposition":"Bubbles","justification":""},{"idx":3,"correct":false,"proposition":"Pustules","justification":""},{"idx":4,"correct":true,"proposition":"Erosions","justification":""}],"type":"dp"}
{"_id":"annales-2019-dp-4-qi-2","context":"A 76-year-old man consults for a bullous rash that appeared for a few days. He has been treated for heart failure for 13 years with beta-blocker (bisoprolol) and a combination of an angiotensin receptor type 2 antagonist and a diuretic (valsartan, hydrochlorothiazide). He also has type 2 diabetes treated with diet and metformin. He lives with his disabled wife. He complains of pruritus and dry skin for about 8 months. The clinical examination reveals bubbles in the trunk and upper limbs (Photo). Examination of the mucous membranes is normal. It presents an average of 30 new bubbles per day. He has been applying for several weeks a topical corticosteroid of moderate activity (desonide) associated with a dose of 25 mg of hydroxyzine (anti-histamine) at bedtime. ","enonce":"Which diagnostic hypothesis do you prefer in front of this table? ","item":"annales-2019-dp-4","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Pemphigus vulgaris","justification":""},{"idx":1,"correct":false,"proposition":"Bullous taxidermy","justification":""},{"idx":2,"correct":false,"proposition":"Porphyria cutanea tarda","justification":""},{"idx":3,"correct":true,"proposition":"Bullous pemphigoid","justification":""},{"idx":4,"correct":false,"proposition":"Generalized shingles","justification":""}],"type":"dp"}
{"_id":"annales-2019-dp-4-qi-3","context":"A 76-year-old man consults for a bullous rash that appeared for a few days. He has been treated for heart failure for 13 years with beta-blocker (bisoprolol) and a combination of an angiotensin receptor type 2 antagonist and a diuretic (valsartan, hydrochlorothiazide). He also has type 2 diabetes treated with diet and metformin. He lives with his disabled wife. He complains of pruritus and dry skin for about 8 months. The clinical examination reveals bubbles in the trunk and upper limbs (Photo). Examination of the mucous membranes is normal. It presents an average of 30 new bubbles per day. He has been applying for several weeks a topical corticosteroid of moderate activity (desonide) associated with a dose of 25 mg of hydroxyzine (anti-histamine) at bedtime. ","enonce":"You suspect a bullous pemphigoid. Which of the following characteristics(are) compatible with the diagnosis?","item":"annales-2019-dp-4","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Bubbles in healthy skin","justification":""},{"idx":1,"correct":true,"proposition":"Tense bubbles","justification":""},{"idx":2,"correct":false,"proposition":"Predominant mucosal involvement","justification":"This is found in pemphigus and hereditary epidermolysis bullosa (which is found in children), for example."},{"idx":3,"correct":true,"proposition":"A localization at the root of the members","justification":""},{"idx":4,"correct":true,"proposition":"Intense pruritus","justification":"This is a classic symptom"}],"type":"dp"}
{"_id":"annales-2019-dp-4-qi-4","context":"A 76-year-old man consults for a bullous rash that appeared for a few days. He has been treated for heart failure for 13 years with beta-blocker (bisoprolol) and a combination of an angiotensin receptor type 2 antagonist and a diuretic (valsartan, hydrochlorothiazide). He also has type 2 diabetes treated with diet and metformin. He lives with his disabled wife. He complains of pruritus and dry skin for about 8 months. The clinical examination reveals bubbles in the trunk and upper limbs (Photo). Examination of the mucous membranes is normal. It presents an average of 30 new bubbles per day. He has been applying for several weeks a topical corticosteroid of moderate activity (desonide) associated with a dose of 25 mg of hydroxyzine (anti-histamine) at bedtime. ","enonce":"Which of the following laboratory tests do you consider in favor of the diagnosis of bullous pemphigoid? Give the correct answer(s).","item":"annales-2019-dp-4","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Sedimentation rate greater than 100mm at the first hour","justification":""},{"idx":1,"correct":false,"proposition":"Neutrophil polynucleosis","justification":""},{"idx":2,"correct":true,"proposition":"Blood eosinophilia","justification":""},{"idx":3,"correct":false,"proposition":"Proteinuria greater than 100 mg\/Day","justification":""},{"idx":4,"correct":false,"proposition":"Hypercalcemia","justification":""}],"type":"dp"}
{"_id":"annales-2019-dp-4-qi-5","context":"A 76-year-old man consults for a bullous rash that appeared for a few days. He has been treated for heart failure for 13 years with beta-blocker (bisoprolol) and a combination of an angiotensin receptor type 2 antagonist and a diuretic (valsartan, hydrochlorothiazide). He also has type 2 diabetes treated with diet and metformin. He lives with his disabled wife. He complains of pruritus and dry skin for about 8 months. The clinical examination reveals bubbles in the trunk and upper limbs (Photo). Examination of the mucous membranes is normal. It presents an average of 30 new bubbles per day. He has been applying for several weeks a topical corticosteroid of moderate activity (desonide) associated with a dose of 25 mg of hydroxyzine (anti-histamine) at bedtime. ","enonce":"What paraclinical examination(s) do you perform to confirm the diagnosis of bullous pemphigoid? Give the correct answer(s).","item":"annales-2019-dp-4","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Tzanck cytodiagnosis","justification":""},{"idx":1,"correct":false,"proposition":"Electron microscopy","justification":""},{"idx":2,"correct":true,"proposition":"Biopsy for standard histology","justification":""},{"idx":3,"correct":true,"proposition":"Direct cutaneous immunofluorescence","justification":"Direct to the skin. Indirect for blood 🩸 ."},{"idx":4,"correct":false,"proposition":"Culturing the bubble liquid","justification":""}],"type":"dp"}
{"_id":"annales-2019-dp-4-qi-6","context":"A 76-year-old man consults for a bullous rash that appeared for a few days. He has been treated for heart failure for 13 years with beta-blocker (bisoprolol) and a combination of an angiotensin receptor type 2 antagonist and a diuretic (valsartan, hydrochlorothiazide). He also has type 2 diabetes treated with diet and metformin. He lives with his disabled wife. He complains of pruritus and dry skin for about 8 months. The clinical examination reveals bubbles in the trunk and upper limbs (Photo). Examination of the mucous membranes is normal. It presents an average of 30 new bubbles per day. He has been applying for several weeks a topical corticosteroid of moderate activity (desonide) associated with a dose of 25 mg of hydroxyzine (anti-histamine) at bedtime. ","enonce":"The anatomo-pathological examination of a bubble was carried out (photo). Which element(s) is (are) in favor of the diagnosis of bullous pemphigoid? Bubbles ","item":"annales-2019-dp-4","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Subepidermal cleavage","justification":""},{"idx":1,"correct":false,"proposition":"Intra-epidermal cleavage","justification":"Pemphigus"},{"idx":2,"correct":false,"proposition":"Acantholysis","justification":"There is no acantholysis, nor Nikolsky's sign, in pemphigoid (unlike pemphigus)."},{"idx":3,"correct":false,"proposition":"Keratinocyte necrosis","justification":"Pemphigus"},{"idx":4,"correct":true,"proposition":"A dermal inflammatory infiltrate with predominance of eosinophilic polynuclear (PNE)","justification":""}],"type":"dp"}
{"_id":"annales-2019-dp-4-qi-7","context":"A 76-year-old man consults for a bullous rash that appeared for a few days. He has been treated for heart failure for 13 years with beta-blocker (bisoprolol) and a combination of an angiotensin receptor type 2 antagonist and a diuretic (valsartan, hydrochlorothiazide). He also has type 2 diabetes treated with diet and metformin. He lives with his disabled wife. He complains of pruritus and dry skin for about 8 months. The clinical examination reveals bubbles in the trunk and upper limbs (Photo). Examination of the mucous membranes is normal. It presents an average of 30 new bubbles per day. He has been applying for several weeks a topical corticosteroid of moderate activity (desonide) associated with a dose of 25 mg of hydroxyzine (anti-histamine) at bedtime. ","enonce":"Direct cutaneous immunofluorescence confirms the diagnosis of bullous pemphigoid. Indeed, it highlights (the) following element(s):","item":"annales-2019-dp-4","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Granular deposits of C3 on the dermal-epidermal junction","justification":""},{"idx":1,"correct":true,"proposition":"Linear IgG deposits on the dermal-epidermal junction","justification":""},{"idx":2,"correct":false,"proposition":"Linear deposits of IgA on the dermal-epidermal junction","justification":""},{"idx":3,"correct":false,"proposition":"Intercellular IgM deposits","justification":""},{"idx":4,"correct":true,"proposition":"Linear deposits of C3 on the dermal-epidermal junction","justification":""}],"type":"dp"}
{"_id":"annales-2019-dp-4-qi-8","context":"A 76-year-old man consults for a bullous rash that appeared for a few days. He has been treated for heart failure for 13 years with beta-blocker (bisoprolol) and a combination of an angiotensin receptor type 2 antagonist and a diuretic (valsartan, hydrochlorothiazide). He also has type 2 diabetes treated with diet and metformin. He lives with his disabled wife. He complains of pruritus and dry skin for about 8 months. The clinical examination reveals bubbles in the trunk and upper limbs (Photo). Examination of the mucous membranes is normal. It presents an average of 30 new bubbles per day. He has been applying for several weeks a topical corticosteroid of moderate activity (desonide) associated with a dose of 25 mg of hydroxyzine (anti-histamine) at bedtime. ","enonce":"Which of the following serological tests is the one whose positivity can support the diagnosis of bullous pemphigoid? ","item":"annales-2019-dp-4","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Anti-nuclear antibodies","justification":"Lupus"},{"idx":1,"correct":false,"proposition":"Anti-intercellular substance antibodies","justification":"Pemphigus"},{"idx":2,"correct":true,"proposition":"Anti-basement membrane antibodies","justification":""},{"idx":3,"correct":false,"proposition":"Anti-gliadin antibodies","justification":""},{"idx":4,"correct":false,"proposition":"Anti-thyroperoxidase antibodies","justification":"Hashimoto"}],"type":"dp"}
{"_id":"annales-2019-dp-4-qi-9","context":"A 76-year-old man consults for a bullous rash that appeared for a few days. He has been treated for heart failure for 13 years with beta-blocker (bisoprolol) and a combination of an angiotensin receptor type 2 antagonist and a diuretic (valsartan, hydrochlorothiazide). He also has type 2 diabetes treated with diet and metformin. He lives with his disabled wife. He complains of pruritus and dry skin for about 8 months. The clinical examination reveals bubbles in the trunk and upper limbs (Photo). Examination of the mucous membranes is normal. It presents an average of 30 new bubbles per day. He has been applying for several weeks a topical corticosteroid of moderate activity (desonide) associated with a dose of 25 mg of hydroxyzine (anti-histamine) at bedtime. ","enonce":"Immediate management of this patient requires (one or more exact answer(s)):","item":"annales-2019-dp-4","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"An assessment of his hydration status","justification":""},{"idx":1,"correct":true,"proposition":"High-calorie nutrition","justification":""},{"idx":2,"correct":false,"proposition":"Hospitalization in intensive care","justification":"This would have been true in case of a sign of organic decompensation."},{"idx":3,"correct":false,"proposition":"Broad-spectrum antibiotic therapy","justification":"But we put local antiseptics (on the pierced bubbles)"},{"idx":4,"correct":false,"proposition":"Immediate cessation of treatment for heart failure","justification":"Why do this?"}],"type":"dp"}
{"_id":"annales-2019-dp-4-qi-10","context":"A 76-year-old man consults for a bullous rash that appeared for a few days. He has been treated for heart failure for 13 years with beta-blocker (bisoprolol) and a combination of an angiotensin receptor type 2 antagonist and a diuretic (valsartan, hydrochlorothiazide). He also has type 2 diabetes treated with diet and metformin. He lives with his disabled wife. He complains of pruritus and dry skin for about 8 months. The clinical examination reveals bubbles in the trunk and upper limbs (Photo). Examination of the mucous membranes is normal. It presents an average of 30 new bubbles per day. He has been applying for several weeks a topical corticosteroid of moderate activity (desonide) associated with a dose of 25 mg of hydroxyzine (anti-histamine) at bedtime. ","enonce":"The first-line treatment of bullous pemphigoid in this patient, as recommended by the HAS, is based on (one or more exact response(s)): ","item":"annales-2019-dp-4","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Local corticosteroids of low activity (level 1) 20 to 40 g per day","justification":"No interest, it's a much too weak action"},{"idx":1,"correct":true,"proposition":"Local corticosteroid therapy of very high activity (level IV) 20 to 40 g per day","justification":""},{"idx":2,"correct":false,"proposition":"Cyclophosphamide 50 mg\/day","justification":""},{"idx":3,"correct":false,"proposition":"Intravenous corticosteroid bolus","justification":""},{"idx":4,"correct":false,"proposition":"Plasmapheresis 1 session per week for 4 weeks","justification":""}],"type":"dp"}
{"_id":"annales-2019-dp-4-qi-11","context":"A 76-year-old man consults for a bullous rash that appeared for a few days. He has been treated for heart failure for 13 years with beta-blocker (bisoprolol) and a combination of an angiotensin receptor type 2 antagonist and a diuretic (valsartan, hydrochlorothiazide). He also has type 2 diabetes treated with diet and metformin. He lives with his disabled wife. He complains of pruritus and dry skin for about 8 months. The clinical examination reveals bubbles in the trunk and upper limbs (Photo). Examination of the mucous membranes is normal. It presents an average of 30 new bubbles per day. He has been applying for several weeks a topical corticosteroid of moderate activity (desonide) associated with a dose of 25 mg of hydroxyzine (anti-histamine) at bedtime. ","enonce":"Additional therapeutic and monitoring measures are envisaged. Which of the following proposals do you retain? ","item":"annales-2019-dp-4","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Close monitoring of kidney function","justification":"The risk of dehydration pushes us to monitor kidney function in front of the risk of functional renal failure."},{"idx":1,"correct":false,"proposition":"Prescription of antihistamines","justification":"They are not useful. The best antipruritic is etiological treatment (corticosteroids, with their anti-inflammatory effect, will decrease pruritus)."},{"idx":2,"correct":true,"proposition":"Realization of antiseptic baths","justification":""},{"idx":3,"correct":true,"proposition":"Blood glucose monitoring","justification":""},{"idx":4,"correct":false,"proposition":"Substitution of oral antidiabetic drugs with insulin","justification":"Depending on renal monitoring."}],"type":"dp"}
{"_id":"annales-2019-dp-4-qi-12","context":"A 76-year-old man consults for a bullous rash that appeared for a few days. He has been treated for heart failure for 13 years with beta-blocker (bisoprolol) and a combination of an angiotensin receptor type 2 antagonist and a diuretic (valsartan, hydrochlorothiazide). He also has type 2 diabetes treated with diet and metformin. He lives with his disabled wife. He complains of pruritus and dry skin for about 8 months. The clinical examination reveals bubbles in the trunk and upper limbs (Photo). Examination of the mucous membranes is normal. It presents an average of 30 new bubbles per day. He has been applying for several weeks a topical corticosteroid of moderate activity (desonide) associated with a dose of 25 mg of hydroxyzine (anti-histamine) at bedtime. ","enonce":"After several days of hospitalization, the patient goes home. What action(s) should be taken? ","item":"annales-2019-dp-4","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Out-of-list ALD support","justification":"We start on a very long care. The ALD will make it possible to cover the many medical, drug and paramedical interventions."},{"idx":1,"correct":false,"proposition":"Mandatory notification of the disease","justification":""},{"idx":2,"correct":true,"proposition":"Daily care by IDE at home","justification":""},{"idx":3,"correct":true,"proposition":"Blood sugar control","justification":""},{"idx":4,"correct":false,"proposition":"Disinsection of the home","justification":""}],"type":"dp"}
{"_id":"annales-2019-dp-4-qi-13","context":"A 76-year-old man consults for a bullous rash that appeared for a few days. He has been treated for heart failure for 13 years with beta-blocker (bisoprolol) and a combination of an angiotensin receptor type 2 antagonist and a diuretic (valsartan, hydrochlorothiazide). He also has type 2 diabetes treated with diet and metformin. He lives with his disabled wife. He complains of pruritus and dry skin for about 8 months. The clinical examination reveals bubbles in the trunk and upper limbs (Photo). Examination of the mucous membranes is normal. It presents an average of 30 new bubbles per day. He has been applying for several weeks a topical corticosteroid of moderate activity (desonide) associated with a dose of 25 mg of hydroxyzine (anti-histamine) at bedtime. ","enonce":"After 3 months of a well-conducted treatment with very strong local corticosteroids, the patient still presents bubbles, severe skin atrophy, many milia grains, extensive erosions in the thighs, heel bedsores, ecchymotic purpura of the arms. Which of the following is(s) induced by very strong prolonged corticosteroid therapy? ","item":"annales-2019-dp-4","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Milium grains","justification":""},{"idx":1,"correct":false,"proposition":"Bubble persistence","justification":""},{"idx":2,"correct":true,"proposition":"Ecchymotic purpura","justification":""},{"idx":3,"correct":false,"proposition":"Pressure ulcer heel","justification":"Topical corticosteroids are not a priori applied to the heel."},{"idx":4,"correct":true,"proposition":"Skin atrophy","justification":""}],"type":"dp"}
{"_id":"annales-2019-dp-4-qi-14","context":"A 76-year-old man consults for a bullous rash that appeared for a few days. He has been treated for heart failure for 13 years with beta-blocker (bisoprolol) and a combination of an angiotensin receptor type 2 antagonist and a diuretic (valsartan, hydrochlorothiazide). He also has type 2 diabetes treated with diet and metformin. He lives with his disabled wife. He complains of pruritus and dry skin for about 8 months. The clinical examination reveals bubbles in the trunk and upper limbs (Photo). Examination of the mucous membranes is normal. It presents an average of 30 new bubbles per day. He has been applying for several weeks a topical corticosteroid of moderate activity (desonide) associated with a dose of 25 mg of hydroxyzine (anti-histamine) at bedtime. ","enonce":"As the patient relapses with each attempt to reduce local corticosteroid therapy, a change in treatment is considered. Methotrexate treatment was then initiated, allowing complete regression of bubbles and pruritus. After 3 months of treatment, the patient presents with a sudden fever at 38.5 ° C associated with a hot and painful edema of the right leg surmounted by a few bubbles. What diagnosis(s) do you mention? ","item":"annales-2019-dp-4","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Erysipelas","justification":"The description is typical 😊"},{"idx":1,"correct":false,"proposition":"Cutaneous candidiasis","justification":""},{"idx":2,"correct":false,"proposition":"A recurrence of bullous pemphigoid","justification":""},{"idx":3,"correct":false,"proposition":"Shingles","justification":""},{"idx":4,"correct":false,"proposition":"Contact eczema","justification":""}],"type":"dp"}
{"_id":"annales-2019-dp-4-qi-15","context":"A 76-year-old man consults for a bullous rash that appeared for a few days. He has been treated for heart failure for 13 years with beta-blocker (bisoprolol) and a combination of an angiotensin receptor type 2 antagonist and a diuretic (valsartan, hydrochlorothiazide). He also has type 2 diabetes treated with diet and metformin. He lives with his disabled wife. He complains of pruritus and dry skin for about 8 months. The clinical examination reveals bubbles in the trunk and upper limbs (Photo). Examination of the mucous membranes is normal. It presents an average of 30 new bubbles per day. He has been applying for several weeks a topical corticosteroid of moderate activity (desonide) associated with a dose of 25 mg of hydroxyzine (anti-histamine) at bedtime. ","enonce":"Bacteriological sampling of bubble fluid identifies group B streptococcus. What treatment do you offer as a first-line treatment? ","item":"annales-2019-dp-4","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Fusidic acid cream","justification":""},{"idx":1,"correct":true,"proposition":"Amoxicillin","justification":"It is the treatment of choice for Streptococcus pyogenes."},{"idx":2,"correct":false,"proposition":"Doxycycline","justification":""},{"idx":3,"correct":false,"proposition":"Terbinafine","justification":""},{"idx":4,"correct":false,"proposition":"Trimethoprim-sulfamethoxazole","justification":""}],"type":"dp"}
{"_id":"annales-2019-dp-10-qi-1","context":"Ms B, 35, consults her GP for unusual asthenia. In his medical history, we note: - substituted hypothyroidism; - a road accident in 1990 with multiple fractures and transfusions; - post-transfusion hepatitis C cured; - superficial venous thrombosis 2 years ago; Never deep thrombosis - no pregnancy The patient's usual treatment includes: levothyroxine 75 µg.","enonce":"Which of the following questioning elements could (could) discriminate against the cause of the asthenia presented by your patient? (one or more true propositions) ","item":"annales-2019-dp-10","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Do you regularly forget your treatment?","justification":""},{"idx":1,"correct":true,"proposition":"Do you snore?","justification":""},{"idx":2,"correct":true,"proposition":"Have you lost weight?","justification":""},{"idx":3,"correct":false,"proposition":"Did your fatigue necessitate a work stoppage?","justification":""},{"idx":4,"correct":true,"proposition":"Do you feel sad?","justification":""}],"type":"dp"}
{"_id":"annales-2019-dp-10-qi-2","context":"Ms B, 35, consults her GP for unusual asthenia. In his medical history, we note: - substituted hypothyroidism; - a road accident in 1990 with multiple fractures and transfusions; - post-transfusion hepatitis C cured; - superficial venous thrombosis 2 years ago; Never deep thrombosis - no pregnancy The patient's usual treatment includes: levothyroxine 75 µg.","enonce":"Your patient reports that this unusual fatigue has been evolving in recent weeks. Weight is stable, sleep is preserved. The patient does not have mood sadness or other elements suggestive of a depressive syndrome. This fatigue increases during the day and with effort, and is associated with dyspnea also with effort. In general, what is the exact clinical element(s)? (one or more true propositions)","item":"annales-2019-dp-10","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Mucocutaneous pallor is specific for anemic syndrome","justification":"Sensitive but non-specific"},{"idx":1,"correct":false,"proposition":"An asthenia that increases during the day is specific to an organic cause","justification":"'Specific' and 'asthenia' are oxymorons 😉"},{"idx":2,"correct":true,"proposition":"Weight loss with preserved or even increased appetite can lead to endocrinopathy","justification":"Like diabetes for example"},{"idx":3,"correct":false,"proposition":"Melanonychia can lead to a martial deficiency","justification":""},{"idx":4,"correct":true,"proposition":"Melanoderma can lead to adrenal insufficiency","justification":""}],"type":"dp"}
{"_id":"annales-2019-dp-10-qi-3","context":"Ms B, 35, consults her GP for unusual asthenia. In his medical history, we note: - substituted hypothyroidism; - a road accident in 1990 with multiple fractures and transfusions; - post-transfusion hepatitis C cured; - superficial venous thrombosis 2 years ago; Never deep thrombosis - no pregnancy The patient's usual treatment includes: levothyroxine 75 µg.","enonce":"At the interview, the patient described dark urine for about 15 days. Your patient's diet appears to be balanced, and she does not report any recent drug introduction. She describes an old tendency to constipation. Blood pressure is measured at 125\/70, heart rate at 100\/min. The abdominal examination finds a splenomegaly, without associated hepatomegaly. Which of the following diagnostic hypotheses seems most likely to explain all the clinical elements (a single expected response)? ","item":"annales-2019-dp-10","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Hypothyroidism","justification":""},{"idx":1,"correct":false,"proposition":"Heart failure","justification":""},{"idx":2,"correct":false,"proposition":"Multiple myeloma","justification":""},{"idx":3,"correct":true,"proposition":"Hemolytic anemia","justification":""},{"idx":4,"correct":false,"proposition":"Cholangiocarcinoma","justification":""}],"type":"dp"}
{"_id":"annales-2019-dp-10-qi-4","context":"Ms B, 35, consults her GP for unusual asthenia. In his medical history, we note: - substituted hypothyroidism; - a road accident in 1990 with multiple fractures and transfusions; - post-transfusion hepatitis C cured; - superficial venous thrombosis 2 years ago; Never deep thrombosis - no pregnancy The patient's usual treatment includes: levothyroxine 75 µg.","enonce":"The patient presents the results of a blood count performed the previous week at the request of her general practitioner: hemoglobin 7.5 g\/dL, MCV 102 fL, leukocytes 5.5 G\/L, complete blood count with polynuclear (PN) neutrophils 3.8 G\/L, eosinophilic PN 0.08 G\/L, basophilic PN 0.02 G\/L, lymphocytes 1.2 G\/L, monocytes 0.46 G\/L,  1, blisters 160 g\/l. \nAt this stage of the care, which of the following additional examinations seems to you (seem) lawful to prescribe as a first intention? (one or more exact propositions)","item":"annales-2019-dp-10","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Transthoracic cardiac ultrasound","justification":""},{"idx":1,"correct":false,"proposition":"Pulmonary function tests","justification":""},{"idx":2,"correct":false,"proposition":"Ferritinemia"},{"idx":3,"correct":true,"proposition":"Blood grouping and search for irregular agglutinins","justification":"We may have to transfuse it"},{"idx":4,"correct":true,"proposition":"Reticulocyte count"}],"type":"dp"}
{"_id":"annales-2019-dp-10-qi-5","context":"Ms B, 35, consults her GP for unusual asthenia. In his medical history, we note: - substituted hypothyroidism; - a road accident in 1990 with multiple fractures and transfusions; - post-transfusion hepatitis C cured; - superficial venous thrombosis 2 years ago; Never deep thrombosis - no pregnancy The patient's usual treatment includes: levothyroxine 75 µg.","enonce":"You are looking for arguments for hemolysis, you prescribe: (one or more exact answers) ","item":"annales-2019-dp-10","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Haptoglobin","justification":""},{"idx":1,"correct":false,"proposition":"Beta2-microglobulin","justification":""},{"idx":2,"correct":false,"proposition":"Transferrin saturation coefficient","justification":""},{"idx":3,"correct":true,"proposition":"Free and conjugated bilirubin","justification":""},{"idx":3,"correct":true,"proposition":"Lactate Desydrogenase (LDH)","justification":""}],"type":"dp"}
{"_id":"annales-2019-dp-10-qi-6","context":"Ms B, 35, consults her GP for unusual asthenia. In his medical history, we note: - substituted hypothyroidism; - a road accident in 1990 with multiple fractures and transfusions; - post-transfusion hepatitis C cured; - superficial venous thrombosis 2 years ago; Never deep thrombosis - no pregnancy The patient's usual treatment includes: levothyroxine 75 µg.","enonce":"The patient is hospitalized and additional blood tests are performed urgently, resulting in: hemoglobin 6.9 g\/dL, MCV 103 fi; reticulocytes 300 G\/L, leukocytes 6, 1 G\/L, complete blood count with polynuclear (PN) neutrophils 4.2 G\/L, Eosinophilic PN 0.08 G\/L, Basophilic PN: 0.02 G\/L, lymphocytes 1.3 G\/L, monocytes 0.46, platelets 150 G\/L, Na 145 mmol\/L; K 4.5 mmol\/L; Cl 105 mmol\/L; urea 3.5 mmol\/L; creatinine 74 μmol\/L; C-reactive protein 3.6 mg\/L; LDH 772 IU\/L; total bilirubin 40 μmol\/L; conjugated bilirubin 5 μmol\/L; AST 50 IU\/L (N: 8-35); ALT 45 IU\/L (N: 8-25); alkaline phosphatase 54 IU\/L; GGT 53 IU\/L; Haptoglobin < 0.1 g\/L. Apart from the erythrocyte Coombs test (direct antiglobulin test), which of the following tests seems most relevant to you to complete, at this stage, the assessment of your patient (only one expected response) ","item":"annales-2019-dp-10","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Serum vitamin B12 determination","justification":""},{"idx":1,"correct":false,"proposition":"TSH test","justification":""},{"idx":2,"correct":true,"proposition":"Blood smear","justification":""},{"idx":3,"correct":false,"proposition":"Blood lead level","justification":""},{"idx":4,"correct":false,"proposition":"Determination of ADAMTS13 activity","justification":""}],"type":"dp"}
{"_id":"annales-2019-dp-10-qi-7","context":"Ms B, 35, consults her GP for unusual asthenia. In his medical history, we note: - substituted hypothyroidism; - a road accident in 1990 with multiple fractures and transfusions; - post-transfusion hepatitis C cured; - superficial venous thrombosis 2 years ago; Never deep thrombosis - no pregnancy The patient's usual treatment includes: levothyroxine 75 µg.","enonce":"Against this background of hemolytic anemia, this patient is referred to a colleague internist. He asks the biologist of the hematology laboratory to perform a blood smear. In general, which of the following pathological situations can (or which) be evoked thanks to the blood smear data? ","item":"annales-2019-dp-10","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Viral infection with mononucleosis syndrome","justification":""},{"idx":1,"correct":true,"proposition":"Thrombotic microangiopathies","justification":""},{"idx":2,"correct":false,"proposition":"Paroxysmal nocturnal hemoglobinuria","justification":""},{"idx":3,"correct":true,"proposition":"Parasitic Plasmodium infection","justification":""},{"idx":4,"correct":false,"proposition":"MGUS","justification":"Plasma protein electrophoresis (PEP) is done"}],"type":"dp"}
{"_id":"annales-2019-dp-10-qi-8","context":"Ms B, 35, consults her GP for unusual asthenia. In his medical history, we note: - substituted hypothyroidism; - a road accident in 1990 with multiple fractures and transfusions; - post-transfusion hepatitis C cured; - superficial venous thrombosis 2 years ago; Never deep thrombosis - no pregnancy The patient's usual treatment includes: levothyroxine 75 µg.","enonce":"The blood smear performed on your patient does not find schizocytes or abnormal cells. It is noted the presence of a few spherocytes. You are faxed the first results of the erythrocyte Coombs test (direct antiglobulin test), which are presented below. \nIn view of the above results, which diagnosis do you think is most likely? (only 1 answer expected)","item":"annales-2019-dp-10","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Warm antibody autoimmune hemolytic anemia","justification":""},{"idx":1,"correct":false,"proposition":"Cold agglutinin disease","justification":""},{"idx":2,"correct":false,"proposition":"Paroxysmal haemoglobinuria 'a frigore'","justification":""},{"idx":3,"correct":false,"proposition":"Hereditary spherocytosis"},{"idx":4,"correct":false,"proposition":"Post-transfusion alloimmune hemolytic anemia","justification":""}],"type":"dp"}
{"_id":"annales-2019-dp-10-qi-9","context":"Ms B, 35, consults her GP for unusual asthenia. In his medical history, we note: - substituted hypothyroidism; - a road accident in 1990 with multiple fractures and transfusions; - post-transfusion hepatitis C cured; - superficial venous thrombosis 2 years ago; Never deep thrombosis - no pregnancy The patient's usual treatment includes: levothyroxine 75 µg.","enonce":"The patient is referred to a colleague internist. The diagnosis of hemolytic autoimmune anemia (AHAI) with hot antibodies is retained. Which of the following pathologies can (may) be associated with hot antibody AIHA? ","item":"annales-2019-dp-10","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Systemic scleroderma","justification":""},{"idx":1,"correct":true,"proposition":"Systemic lupus","justification":""},{"idx":2,"correct":true,"proposition":"Non-Hodgkin lymphoma","justification":""},{"idx":3,"correct":true,"proposition":"Chronic lymphocytic leukemia","justification":""},{"idx":4,"correct":true,"proposition":"Common variable immunodeficiency (VICD)","justification":""}],"type":"dp"}
{"_id":"annales-2019-dp-10-qi-10","context":"Ms B, 35, consults her GP for unusual asthenia. In his medical history, we note: - substituted hypothyroidism; - a road accident in 1990 with multiple fractures and transfusions; - post-transfusion hepatitis C cured; - superficial venous thrombosis 2 years ago; Never deep thrombosis - no pregnancy The patient's usual treatment includes: levothyroxine 75 µg.","enonce":"Which of the following additional examinations will you perform on your patient?","item":"annales-2019-dp-10","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Serum protein electrophoresis","justification":""},{"idx":1,"correct":true,"proposition":"HIV serology","justification":""},{"idx":2,"correct":false,"proposition":"Anti-cytoplasmic antibodies of neutrophils","justification":""},{"idx":3,"correct":true,"proposition":"Anti-nuclear antibodies","justification":""},{"idx":4,"correct":false,"proposition":"Bone scintigraphy","justification":""}],"type":"dp"}
{"_id":"annales-2019-dp-10-qi-11","context":"Ms B, 35, consults her GP for unusual asthenia. In his medical history, we note: - substituted hypothyroidism; - a road accident in 1990 with multiple fractures and transfusions; - post-transfusion hepatitis C cured; - superficial venous thrombosis 2 years ago; Never deep thrombosis - no pregnancy The patient's usual treatment includes: levothyroxine 75 µg.","enonce":"The additional assessment carried out on your patient is as follows. \nThe thoraco-abdominopelvic CT scan shows splenomegaly measured at 13 cm, as well as multiple infracentimetric lymphadenopathy cervical, mediastinal, laparomesenteric, retro-aortic and bilateral inguinal. \nBlood tests show: negative anti-HBc antibodies (Ac); Ac anti-HBs negative; HBsAg negative; HCV ac positive; HCV RNA testing by negative quantitative PCR; HIV negative serology. \nBy resuming the interrogation, the patient reports joint pain of the wrists and fingers, predominant in the morning and waking her up at night, evolving for several weeks with episodes of joint swelling. She has developed a rash after exposure to the sun for 2 summers. She also describes dry mouth, and a feeling of grains of sand in the eyes for a few months.\nWhich of the following diagnoses is compatible with the clinical-biological picture presented by your patient?","item":"annales-2019-dp-10","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Secondary Gougerot-Sjogren syndrome","justification":"We must not forget this proposal! We are guided by SSA\/SSB which are positive as well as dry mouth and eyes."},{"idx":1,"correct":false,"proposition":"Secondary anti-phospholipid antibody syndrome","justification":""},{"idx":2,"correct":false,"proposition":"Rheumatoid arthritis"},{"idx":3,"correct":true,"proposition":"Systemic lupus"},{"idx":4,"correct":false,"proposition":"Cryoglobulinemia type 1"}],"type":"dp"}
{"_id":"annales-2019-dp-10-qi-12","context":"Ms B, 35, consults her GP for unusual asthenia. In his medical history, we note: - substituted hypothyroidism; - a road accident in 1990 with multiple fractures and transfusions; - post-transfusion hepatitis C cured; - superficial venous thrombosis 2 years ago; Never deep thrombosis - no pregnancy The patient's usual treatment includes: levothyroxine 75 µg.","enonce":"You retain the diagnosis of systemic lupus with secondary Gougerot-Sjôgren's syndrome, and complicated autoimmune hemolytic anemia with warm antibodies. Which of the following treatments will you start as part of your patient's care? ","item":"annales-2019-dp-10","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Hydroxychloroquine","justification":""},{"idx":1,"correct":true,"proposition":"Systemic corticosteroid therapy","justification":""},{"idx":2,"correct":false,"proposition":"Curative anticoagulation","justification":""},{"idx":3,"correct":true,"proposition":"Pneumococcal vaccination","justification":"Due to long-term systemic corticosteroid therapy"},{"idx":4,"correct":false,"proposition":"Haemophilus influenzae vaccination","justification":""}],"type":"dp"}
{"_id":"annales-2019-dp-10-qi-13","context":"Ms B, 35, consults her GP for unusual asthenia. In his medical history, we note: - substituted hypothyroidism; - a road accident in 1990 with multiple fractures and transfusions; - post-transfusion hepatitis C cured; - superficial venous thrombosis 2 years ago; Never deep thrombosis - no pregnancy The patient's usual treatment includes: levothyroxine 75 µg.","enonce":"You are starting treatment with synthetic antimalarials (hydroxychloroquine) and oral systemic corticosteroids at 1 mg\/kg\/day, with measures associated with usual corticosteroid therapy. \nThe patient and her entourage ask you about the expected evolution and prognostic elements associated with her autoimmune disease. \nWhich of the following information(s) will you provide to your patient?","item":"annales-2019-dp-10","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Pregnancies are contraindicated due to the risk of gestational lupus flare-up","justification":""},{"idx":1,"correct":false,"proposition":"The activity of the disease worsens after menopause","justification":""},{"idx":2,"correct":true,"proposition":"Kidney damage should be routinely screened even in the absence of other symptoms of the disease","justification":""},{"idx":3,"correct":true,"proposition":"The risk of atherosclerosis is increased","justification":""},{"idx":4,"correct":true,"proposition":"The risk of infections is increased","justification":""}],"type":"dp"}
{"_id":"annales-2019-dp-10-qi-14","context":"Ms B, 35, consults her GP for unusual asthenia. In his medical history, we note: - substituted hypothyroidism; - a road accident in 1990 with multiple fractures and transfusions; - post-transfusion hepatitis C cured; - superficial venous thrombosis 2 years ago; Never deep thrombosis - no pregnancy The patient's usual treatment includes: levothyroxine 75 µg.","enonce":"While corticosteroid therapy has just been started, your patient reports retrosternal chest pain constrictive to exercise. The control of the blood count finds a hemoglobin assay at 4.8 g \/ dL. You decide to transfuse your patient urgently. Regarding the realization of this transfusion of red blood cells (CGR), which of the following proposals is (are) accurate?","item":"annales-2019-dp-10","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"CGR for clinical use are systematically subject to leukocyte removal","justification":""},{"idx":1,"correct":true,"proposition":"The transfusion of a CGR issued must begin within 6 hours of arrival in the clinical department","justification":""},{"idx":2,"correct":false,"proposition":"There is an indication to prescribe irradiated CGR in the case of your patient","justification":""},{"idx":3,"correct":true,"proposition":"It is recommended to use RH-KEL 1 phenocompatible CGRs in the case of your patient","justification":"Because it is likely that it is polytransfused"},{"idx":4,"correct":false,"proposition":"It is recommended to use deplasmatized RGCs in the case of your patient","justification":""}],"type":"dp"}
{"_id":"annales-2019-dp-10-qi-15","context":"Ms B, 35, consults her GP for unusual asthenia. In his medical history, we note: - substituted hypothyroidism; - a road accident in 1990 with multiple fractures and transfusions; - post-transfusion hepatitis C cured; - superficial venous thrombosis 2 years ago; Never deep thrombosis - no pregnancy The patient's usual treatment includes: levothyroxine 75 µg.","enonce":"The transfusion is well tolerated, chest pain regresses and the ECG normalizes after transfusion. Corticosteroid therapy is finally effective, with regression of the biological stigmas of hemolysis in a few days, and gradual ascent of the hemoglobin (Hb) count. However, while a decrease in the dosage of prednisone is achieved, there is a relapse of autoimmune hemolytic anemia 3 months later with resumption of hemolysis markers and further decrease in Hb level below 10 g \/ dL. Treatment with rituximab is then considered in your patient. Regarding this biotherapy, which of the following proposition(s) is (are) accurate? ","item":"annales-2019-dp-10","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"11 is a monoclonal antibody to CD34","justification":""},{"idx":1,"correct":false,"proposition":"It is a targeted therapy against T cells","justification":"Against B lymphocytes (it is an anti-CD20)"},{"idx":2,"correct":true,"proposition":"Pneumococcal vaccination should be performed before the first infusion","justification":""},{"idx":3,"correct":true,"proposition":"Anti-allergic premedication is systematically carried out before infusions","justification":""},{"idx":4,"correct":true,"proposition":"The occurrence of hypogammaglobulinemia should be detected during this treatment","justification":""}],"type":"dp"}
{"_id":"annales-2019-dp-13-qi-1","context":"A 42-year-old patient comes to see you at your office for febrile pharyngeal pain. This lady's main history is a road accident in 2001 with ruptured spleen requiring partial splenectomy, unlabeled episodes of tachycardia, essential hypertension treated with hydrochlorothiazide and chronic alcoholism (8 cans of beer per day). She smokes a pack of cigarettes a day. She is a mother of 4 children but lives alone, custody of her children having been taken away from her. She is currently unemployed (former cleaner), occasionally has paid sex. She has had a fever and throat pain for 24 hours. The throat exam is as follows:","enonce":"What clinical data(s) should you particularly research in this context to refine the diagnosis and management of this ENT problem? ","item":"annales-2019-dp-13","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Odynophagy","justification":"It's the esophagus ^^ So it's not ENT"},{"idx":1,"correct":true,"proposition":"Fever intensity","justification":"Enters Mac Isaac's score"},{"idx":2,"correct":true,"proposition":"Conjunctivitis","justification":"Conjunctivitis possibly associated with an ENT problem, which changes its management"},{"idx":3,"correct":true,"proposition":"Cough","justification":"Enters Mac Isaac's score"},{"idx":4,"correct":true,"proposition":"Cervical lymphadenopathy","justification":"Enters Mac Isaac's score"}],"type":"dp"}
{"_id":"annales-2019-dp-13-qi-2","context":"A 42-year-old patient comes to see you at your office for febrile pharyngeal pain. This lady's main history is a road accident in 2001 with ruptured spleen requiring partial splenectomy, unlabeled episodes of tachycardia, essential hypertension treated with hydrochlorothiazide and chronic alcoholism (8 cans of beer per day). She smokes a pack of cigarettes a day. She is a mother of 4 children but lives alone, custody of her children having been taken away from her. She is currently unemployed (former cleaner), occasionally has paid sex. She has had a fever and throat pain for 24 hours. The throat exam is as follows:","enonce":"The fever is at 38.9 ° C, a blood pressure at 120\/75 mmHg, a heart rate at 84 \/ min, a respiratory rate at 15 \/ min, laterocervical lymphadenopathy and a rather dry cough with some ronchi on pulmonary auscultation. The dental condition is bad with several teeth to treat or extract. You also notice a lesion at the top of the right thigh, near the groin crease, of which the patient does not really complain, << used to >>. Regarding the skin lesion, what is(are) your diagnostic hypothesis(s)? ","item":"annales-2019-dp-13","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Boil","justification":""},{"idx":1,"correct":false,"proposition":"Pyoderma gangrenosum","justification":"It is found associated with Crohn's"},{"idx":2,"correct":false,"proposition":"Impetigo","justification":""},{"idx":3,"correct":false,"proposition":"Borrelian lymphocytoma","justification":""},{"idx":4,"correct":false,"proposition":"Lymphangitis","justification":""}],"type":"dp"}
{"_id":"annales-2019-dp-13-qi-3","context":"A 42-year-old patient comes to see you at your office for febrile pharyngeal pain. This lady's main history is a road accident in 2001 with ruptured spleen requiring partial splenectomy, unlabeled episodes of tachycardia, essential hypertension treated with hydrochlorothiazide and chronic alcoholism (8 cans of beer per day). She smokes a pack of cigarettes a day. She is a mother of 4 children but lives alone, custody of her children having been taken away from her. She is currently unemployed (former cleaner), occasionally has paid sex. She has had a fever and throat pain for 24 hours. The throat exam is as follows:","enonce":"It is indeed a boil. What could be the complications of this thigh boil? ","item":"annales-2019-dp-13","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Subcutaneous abscess","justification":""},{"idx":1,"correct":true,"proposition":"Acute dermohypodermatitis","justification":""},{"idx":2,"correct":false,"proposition":"Femoral iliac thrombophlebitis","justification":""},{"idx":3,"correct":true,"proposition":"Lymphangitis","justification":"The boil can be complicated by lymphangitis, furunculosis, antrax, dermohypodermitis, rare and severe malignant staphyllococcal disease of the face."},{"idx":4,"correct":false,"proposition":"Malignant staphylococcal disease","justification":"Only at the level of the face"}],"type":"dp"}
{"_id":"annales-2019-dp-13-qi-4","context":"A 42-year-old patient comes to see you at your office for febrile pharyngeal pain. This lady's main history is a road accident in 2001 with ruptured spleen requiring partial splenectomy, unlabeled episodes of tachycardia, essential hypertension treated with hydrochlorothiazide and chronic alcoholism (8 cans of beer per day). She smokes a pack of cigarettes a day. She is a mother of 4 children but lives alone, custody of her children having been taken away from her. She is currently unemployed (former cleaner), occasionally has paid sex. She has had a fever and throat pain for 24 hours. The throat exam is as follows:","enonce":"Regarding the immediate management of this patient, which of the following proposition(s) is\/are accurate: (one or more true propositions)","item":"annales-2019-dp-13","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Mc Isaac's score is strictly less than 3","justification":"She has tonsils, lymphadenopathy and fever = Score at 3"},{"idx":1,"correct":true,"proposition":"A rapid diagnostic test for group A streptococcus is required","justification":"His Mac Isacc is positive"},{"idx":2,"correct":false,"proposition":"The patient must be hospitalized","justification":""},{"idx":3,"correct":false,"proposition":"Probabilistic antibiotic therapy needs to be initiated quickly","justification":""},{"idx":4,"correct":false,"proposition":"Tetanus gamma globulins should be administered in the absence of information on vaccination status","justification":""}],"type":"dp"}
{"_id":"annales-2019-dp-13-qi-5","context":"A 42-year-old patient comes to see you at your office for febrile pharyngeal pain. This lady's main history is a road accident in 2001 with ruptured spleen requiring partial splenectomy, unlabeled episodes of tachycardia, essential hypertension treated with hydrochlorothiazide and chronic alcoholism (8 cans of beer per day). She smokes a pack of cigarettes a day. She is a mother of 4 children but lives alone, custody of her children having been taken away from her. She is currently unemployed (former cleaner), occasionally has paid sex. She has had a fever and throat pain for 24 hours. The throat exam is as follows:","enonce":"The rapid diagnostic test for group A streptococcus is positive. What antibiotic treatment do you initiate as a first-line treatment:","item":"annales-2019-dp-13","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Amoxicillin","justification":"We aim for streptococcus, it is the best antibiotic"},{"idx":1,"correct":false,"proposition":"Amoxiclin and clavulanic acid","justification":""},{"idx":2,"correct":false,"proposition":"Pristinamycin","justification":""},{"idx":3,"correct":false,"proposition":"Cefuroxime","justification":""},{"idx":4,"correct":false,"proposition":"Ceftriaxone","justification":""}],"type":"dp"}
{"_id":"annales-2019-dp-13-qi-6","context":"A 42-year-old patient comes to see you at your office for febrile pharyngeal pain. This lady's main history is a road accident in 2001 with ruptured spleen requiring partial splenectomy, unlabeled episodes of tachycardia, essential hypertension treated with hydrochlorothiazide and chronic alcoholism (8 cans of beer per day). She smokes a pack of cigarettes a day. She is a mother of 4 children but lives alone, custody of her children having been taken away from her. She is currently unemployed (former cleaner), occasionally has paid sex. She has had a fever and throat pain for 24 hours. The throat exam is as follows:","enonce":"The clinical course is favorable with amoxicillin. You take the opportunity to check his vaccination status. Which of the following vaccination(s) is (are) recommended in this patient? ","item":"annales-2019-dp-13","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Tetanus","justification":""},{"idx":1,"correct":true,"proposition":"Hepatitis B","justification":""},{"idx":2,"correct":true,"proposition":"Pneumococcus","justification":""},{"idx":3,"correct":true,"proposition":"Haemophilius","justification":"General vaccination"},{"idx":3,"correct":true,"proposition":"Meningococcal group B","justification":"Splenectomized"}],"type":"dp"}
{"_id":"annales-2019-dp-13-qi-7","context":"A 42-year-old patient comes to see you at your office for febrile pharyngeal pain. This lady's main history is a road accident in 2001 with ruptured spleen requiring partial splenectomy, unlabeled episodes of tachycardia, essential hypertension treated with hydrochlorothiazide and chronic alcoholism (8 cans of beer per day). She smokes a pack of cigarettes a day. She is a mother of 4 children but lives alone, custody of her children having been taken away from her. She is currently unemployed (former cleaner), occasionally has paid sex. She has had a fever and throat pain for 24 hours. The throat exam is as follows:","enonce":"You had planned to see the patient again to ensure the evolution, update her vaccination schedule and promote the management of her various comorbidities but the patient never came to your office. She comes to see your colleague at the office almost a year later because she is bothered by a cough evolving for a month, with abundant sputum and night sweats. She has been eating very little for a week because she feels nauseous and very depressed. The temperature is 38.7 °C, blood pressure is 145\/85 mmHg, respiratory rate is 22\/min, heart rate is 92\/min. There are many crackling sounds with a marked decrease in vesicular murmur in the right upper lung field, and the sputum it produces in front of you is greenish and smelly. She has not undertaken any dental care. Which of the following proposals for immediate care is the most appropriate measure? ","item":"annales-2019-dp-13","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Hospitalize the patient","justification":""},{"idx":1,"correct":false,"proposition":"Initiating probabilistic antibiotic therapy","justification":""},{"idx":2,"correct":false,"proposition":"Have the patient have a chest x-ray performed","justification":""},{"idx":3,"correct":false,"proposition":"Have the patient perform a cytobacteriological examination of the sputum","justification":""},{"idx":4,"correct":false,"proposition":"Have the patient perform a biological assessment (NFR, CRP, PCT, blood cultures in particular)","justification":"Will be done, in hospitalization"}],"type":"dp"}
{"_id":"annales-2019-dp-13-qi-8","context":"A 42-year-old patient comes to see you at your office for febrile pharyngeal pain. This lady's main history is a road accident in 2001 with ruptured spleen requiring partial splenectomy, unlabeled episodes of tachycardia, essential hypertension treated with hydrochlorothiazide and chronic alcoholism (8 cans of beer per day). She smokes a pack of cigarettes a day. She is a mother of 4 children but lives alone, custody of her children having been taken away from her. She is currently unemployed (former cleaner), occasionally has paid sex. She has had a fever and throat pain for 24 hours. The throat exam is as follows:","enonce":"The patient is hospitalized and you take care of her. In view of the clinical evidence you have, which of the following are you adopting immediately? ","item":"annales-2019-dp-13","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Isolation << contact >>","justification":""},{"idx":1,"correct":true,"proposition":"Isolation << air >>","justification":"Tuberculosis is suspected"},{"idx":2,"correct":false,"proposition":"Hospitalization in overpressure room","justification":"True in immunocompromised patients"},{"idx":3,"correct":false,"proposition":"Treatment with levofloxacin for pneumococcal purposes","justification":""},{"idx":4,"correct":false,"proposition":"Pneumococcal serovaccination","justification":""}],"type":"dp"}
{"_id":"annales-2019-dp-13-qi-9","context":"A 42-year-old patient comes to see you at your office for febrile pharyngeal pain. This lady's main history is a road accident in 2001 with ruptured spleen requiring partial splenectomy, unlabeled episodes of tachycardia, essential hypertension treated with hydrochlorothiazide and chronic alcoholism (8 cans of beer per day). She smokes a pack of cigarettes a day. She is a mother of 4 children but lives alone, custody of her children having been taken away from her. She is currently unemployed (former cleaner), occasionally has paid sex. She has had a fever and throat pain for 24 hours. The throat exam is as follows:","enonce":"Which of the following exams do you perform quickly? ","item":"annales-2019-dp-13","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Cytobacteriological examination of sputum","justification":""},{"idx":1,"correct":true,"proposition":"Search for acid-alcohol-resistant bacilli in sputum","justification":""},{"idx":2,"correct":false,"proposition":"Bronchoalveolar lavage","justification":"If ECBC fails"},{"idx":3,"correct":false,"proposition":"Gastric tubing in search of acid-alcohol-resistant bacilli","justification":"If ECBC fails"},{"idx":4,"correct":true,"proposition":"Chest X-ray","justification":""}],"type":"dp"}
{"_id":"annales-2019-dp-13-qi-10","context":"A 42-year-old patient comes to see you at your office for febrile pharyngeal pain. This lady's main history is a road accident in 2001 with ruptured spleen requiring partial splenectomy, unlabeled episodes of tachycardia, essential hypertension treated with hydrochlorothiazide and chronic alcoholism (8 cans of beer per day). She smokes a pack of cigarettes a day. She is a mother of 4 children but lives alone, custody of her children having been taken away from her. She is currently unemployed (former cleaner), occasionally has paid sex. She has had a fever and throat pain for 24 hours. The throat exam is as follows:","enonce":"A chest CT scan was actually performed. Which propositions are true?","item":"annales-2019-dp-13","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Right apical abscess lesion"},{"idx":1,"correct":true,"proposition":"Pulmonary condensation ranges"},{"idx":2,"correct":false,"proposition":"Bilateral pleurisy"},{"idx":3,"correct":false,"proposition":"Pericardial calcification"},{"idx":4,"correct":false,"proposition":"Aspect evocative of miliary"}],"type":"dp"}
{"_id":"annales-2019-dp-13-qi-11","context":"A 42-year-old patient comes to see you at your office for febrile pharyngeal pain. This lady's main history is a road accident in 2001 with ruptured spleen requiring partial splenectomy, unlabeled episodes of tachycardia, essential hypertension treated with hydrochlorothiazide and chronic alcoholism (8 cans of beer per day). She smokes a pack of cigarettes a day. She is a mother of 4 children but lives alone, custody of her children having been taken away from her. She is currently unemployed (former cleaner), occasionally has paid sex. She has had a fever and throat pain for 24 hours. The throat exam is as follows:","enonce":"Which of the following infectious agents can (may) classically be involved in abscessed lung damage?","item":"annales-2019-dp-13","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Staphylococcus aureus"},{"idx":1,"correct":true,"proposition":"Klebsiella pneumoniae"},{"idx":2,"correct":false,"proposition":"Treponema pallidum"},{"idx":3,"correct":false,"proposition":"Pneumocystis jiroveci"},{"idx":4,"correct":true,"proposition":"Fusobacterium necrophorum","justification":"In addition, there is strepto, anaerobes, Pseudomonas, Legionella, ..."}],"type":"dp"}
{"_id":"annales-2019-dp-13-qi-12","context":"A 42-year-old patient comes to see you at your office for febrile pharyngeal pain. This lady's main history is a road accident in 2001 with ruptured spleen requiring partial splenectomy, unlabeled episodes of tachycardia, essential hypertension treated with hydrochlorothiazide and chronic alcoholism (8 cans of beer per day). She smokes a pack of cigarettes a day. She is a mother of 4 children but lives alone, custody of her children having been taken away from her. She is currently unemployed (former cleaner), occasionally has paid sex. She has had a fever and throat pain for 24 hours. The throat exam is as follows:","enonce":"In the case of your patient, what biological assessment do you request at this stage? (one or more true propositions)","item":"annales-2019-dp-13","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"HIV serology","justification":""},{"idx":1,"correct":false,"proposition":"D-dimer","justification":""},{"idx":2,"correct":true,"proposition":"Platelet count","justification":""},{"idx":3,"correct":true,"proposition":"Blood","justification":""},{"idx":4,"correct":false,"proposition":"Legionella antigenacuria","justification":""}],"type":"dp"}
{"_id":"annales-2019-dp-13-qi-13","context":"A 42-year-old patient comes to see you at your office for febrile pharyngeal pain. This lady's main history is a road accident in 2001 with ruptured spleen requiring partial splenectomy, unlabeled episodes of tachycardia, essential hypertension treated with hydrochlorothiazide and chronic alcoholism (8 cans of beer per day). She smokes a pack of cigarettes a day. She is a mother of 4 children but lives alone, custody of her children having been taken away from her. She is currently unemployed (former cleaner), occasionally has paid sex. She has had a fever and throat pain for 24 hours. The throat exam is as follows:","enonce":"You also performed a cytobacteriological examination of sputum. Which parameter(s) will make you consider this review to be of quality and reliable? ","item":"annales-2019-dp-13","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Sampling in sputum medium","justification":"It is not a quality criterion"},{"idx":1,"correct":false,"proposition":"Bacterial colonies> 10^3\/mL","justification":"On an ECBC, it's 10^7"},{"idx":2,"correct":false,"proposition":"PNN < 25","justification":"Upper 🤭"},{"idx":3,"correct":true,"proposition":"Epithelial cells < 10","justification":"This question often falls, it is necessary to know these values."},{"idx":4,"correct":true,"proposition":"Monomicrobial","justification":""}],"type":"dp"}
{"_id":"annales-2019-dp-13-qi-14","context":"A 42-year-old patient comes to see you at your office for febrile pharyngeal pain. This lady's main history is a road accident in 2001 with ruptured spleen requiring partial splenectomy, unlabeled episodes of tachycardia, essential hypertension treated with hydrochlorothiazide and chronic alcoholism (8 cans of beer per day). She smokes a pack of cigarettes a day. She is a mother of 4 children but lives alone, custody of her children having been taken away from her. She is currently unemployed (former cleaner), occasionally has paid sex. She has had a fever and throat pain for 24 hours. The throat exam is as follows:","enonce":"Cytobacteriological examination of sputum reveals an anaerobic flora at 10^8\/mL with less than 10 epithelial cells and more than 25 neutrophils per field. The search for acid-alcohol-resistant bacilli is negative on direct examination. Which of the potential gateways do you choose?","item":"annales-2019-dp-13","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Dental","justification":"Anaerobic = ENT, digestive"},{"idx":1,"correct":false,"proposition":"Chronic furunculosis","justification":"Staphs or streptos are not anaerobic 😉"},{"idx":2,"correct":false,"proposition":"Intertrigo"},{"idx":3,"correct":false,"proposition":"Sexual","justification":"Gonococcus, Chlamydia, etc., do not give abscessed pneumonia"},{"idx":4,"correct":false,"proposition":"Urinary"}],"type":"dp"}
{"_id":"annales-2019-dp-13-qi-15","context":"A 42-year-old patient comes to see you at your office for febrile pharyngeal pain. This lady's main history is a road accident in 2001 with ruptured spleen requiring partial splenectomy, unlabeled episodes of tachycardia, essential hypertension treated with hydrochlorothiazide and chronic alcoholism (8 cans of beer per day). She smokes a pack of cigarettes a day. She is a mother of 4 children but lives alone, custody of her children having been taken away from her. She is currently unemployed (former cleaner), occasionally has paid sex. She has had a fever and throat pain for 24 hours. The throat exam is as follows:","enonce":"If, because of the involvement of this anaerobic flora, you decided to include metronidazole in your antibiotic therapy, what adverse effect(s) would you expose the patient? ","item":"annales-2019-dp-13","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Metallic taste in the mouth","justification":""},{"idx":1,"correct":true,"proposition":"Antabuse effect when ingested alcohol","justification":""},{"idx":2,"correct":false,"proposition":"Hypokalaemia in combination with a thiazide diuretic","justification":"Metronidazole is an enzyme inhibitor but does not interact with diuretics."},{"idx":3,"correct":false,"proposition":"Color vision disorder","justification":""},{"idx":4,"correct":true,"proposition":"Neuropathy","justification":""}],"type":"dp"}
{"_id":"annales-2020-dp-13-qi-1","context":"You see in consultation a 57-year-old patient who suffers from epigastric pain progressing by attacks, which lasts several days and is accompanied by nausea. For the last 6 months, these seizures initially recurred once a month. They have now become fortnightly and the patient is forced to restrict his diet because of nausea. There is a progressive weight loss of 7 kg in two years. The patient measures 1m82 and weighs 66 kg. The patient has been an excessive consumer of wine since his military service (one bottle a day) and beer (2 to 3 per day) and has smoked a pack a day since the age of 25. For 6 months this alcohol consumption has been reduced.","enonce":"Given the information already available, what symptom(s) will you look for through the interrogation to guide the diagnosis? ","item":"annales-2020-dp-13","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Presence of abdominal bloating","justification":"Frankly no interest 🤷 ♂️"},{"idx":1,"correct":true,"proposition":"Black coloration of stool","justification":"Melena 💩 = digestive hemorrhage upstream of the small colon-small junction = super interesting information."},{"idx":2,"correct":true,"proposition":"Irradiation of back pain","justification":"Pancreatitis? Colic?"},{"idx":3,"correct":true,"proposition":"Triggering pain by food intake","justification":"Pancreatitis? Colic?"},{"idx":4,"correct":true,"proposition":"Pain relief by taking antacid","justification":"Ulcer?"}],"type":"dp"}
{"_id":"annales-2020-dp-13-qi-2","context":"You see in consultation a 57-year-old patient who suffers from epigastric pain progressing by attacks, which lasts several days and is accompanied by nausea. For the last 6 months, these seizures initially recurred once a month. They have now become fortnightly and the patient is forced to restrict his diet because of nausea. There is a progressive weight loss of 7 kg in two years. The patient measures 1m82 and weighs 66 kg. The patient has been an excessive consumer of wine since his military service (one bottle a day) and beer (2 to 3 per day) and has smoked a pack a day since the age of 25. For 6 months this alcohol consumption has been reduced.","enonce":"The pain radiates to the back and is increased by food intake. The stool is not black. The patient does not take antacid. What are or would be the elements in favor of a pancreatic pathology? (one or more correct answers) ","item":"annales-2020-dp-13","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Weight loss","justification":""},{"idx":1,"correct":true,"proposition":"Dorsal irradiation of pain","justification":""},{"idx":2,"correct":true,"proposition":"The triggering of pain by food intake","justification":""},{"idx":3,"correct":false,"proposition":"Nausea","justification":"Symptom really very aspecific."},{"idx":4,"correct":false,"proposition":"A conjunctival pallor","justification":"Pallor = Anemia = Digestive hemorrhage."}],"type":"dp"}
{"_id":"annales-2020-dp-13-qi-3","context":"You see in consultation a 57-year-old patient who suffers from epigastric pain progressing by attacks, which lasts several days and is accompanied by nausea. For the last 6 months, these seizures initially recurred once a month. They have now become fortnightly and the patient is forced to restrict his diet because of nausea. There is a progressive weight loss of 7 kg in two years. The patient measures 1m82 and weighs 66 kg. The patient has been an excessive consumer of wine since his military service (one bottle a day) and beer (2 to 3 per day) and has smoked a pack a day since the age of 25. For 6 months this alcohol consumption has been reduced.","enonce":"You suspect chronic pancreatic pathology. You request a biological assessment that shows: \n\nAST 32 IU\/L (N < 35); \n\nALT 80 IU\/L (N < 35); \n\nalkaline phosphatases 180 IU\/L (N < 110); \n\ntotal bilirubinemia 25 μmol\/L; conjugated bilirubinemia 15 μmol\/L; \n\ncreatinine 62 μmol\/L; \n\nCRP 5 mg\/L. \n\nWhat is the most relevant complementary exam to schedule? ","item":"annales-2020-dp-13","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Abdominal-pelvic computed tomography without then with injection","justification":""},{"idx":1,"correct":false,"proposition":"Ultrasound of the liver and bile ducts","justification":"This examination would not allow us to directly visualize the pancreas, unlike the AP-CT."},{"idx":2,"correct":false,"proposition":"Endoscopic retrograde cholangiography","justification":""},{"idx":3,"correct":false,"proposition":"Endoscopic ultrasound of the bile ducts","justification":""},{"idx":4,"correct":false,"proposition":"MRI cholangiography","justification":""}],"type":"dp"}
{"_id":"annales-2020-dp-13-qi-4","context":"You see in consultation a 57-year-old patient who suffers from epigastric pain progressing by attacks, which lasts several days and is accompanied by nausea. For the last 6 months, these seizures initially recurred once a month. They have now become fortnightly and the patient is forced to restrict his diet because of nausea. There is a progressive weight loss of 7 kg in two years. The patient measures 1m82 and weighs 66 kg. The patient has been an excessive consumer of wine since his military service (one bottle a day) and beer (2 to 3 per day) and has smoked a pack a day since the age of 25. For 6 months this alcohol consumption has been reduced.","enonce":"You have an abdominal CT scan of which here is an image: The numbers represent anatomical structures. What is the exact answer(s)? ","item":"annales-2020-dp-13","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"1 represents portal vein","justification":"The portal vein would be more anterior. This is the inferior vena cava."},{"idx":1,"correct":true,"proposition":"2 represents a splenic vessel","justification":"You can follow his trajer to the spleen."},{"idx":2,"correct":true,"proposition":"3 represents intra-pancreatic calcification","justification":""},{"idx":3,"correct":false,"proposition":"4 represents the stomach","justification":"A little too far to the right to be the stomach."},{"idx":4,"correct":false,"proposition":"5 represents the left colonist","justification":"The left colon is just lateral. The 5 represents the stomach."}],"type":"dp"}
{"_id":"annales-2020-dp-13-qi-5","context":"You see in consultation a 57-year-old patient who suffers from epigastric pain progressing by attacks, which lasts several days and is accompanied by nausea. For the last 6 months, these seizures initially recurred once a month. They have now become fortnightly and the patient is forced to restrict his diet because of nausea. There is a progressive weight loss of 7 kg in two years. The patient measures 1m82 and weighs 66 kg. The patient has been an excessive consumer of wine since his military service (one bottle a day) and beer (2 to 3 per day) and has smoked a pack a day since the age of 25. For 6 months this alcohol consumption has been reduced.","enonce":"Computed tomography confirmed the diagnosis of chronic calcifying pancreatitis. There is moderate dilation of the intrahepatic bile ducts, and the main bile duct is measured at 10 mm. What transit or stool abnormalities are you looking for when questioned in this context (one or more exact answers)?","item":"annales-2020-dp-13","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Light stools","justification":""},{"idx":1,"correct":true,"proposition":"Very foul-smelling stools","justification":""},{"idx":2,"correct":true,"proposition":"Floating stools","justification":""},{"idx":3,"correct":false,"proposition":"Presence of tenesmus","justification":"Rectal syndrome is not found classically."},{"idx":4,"correct":false,"proposition":"Presence of undigested food in the stool","justification":"This would be found in motor diarrhea, for example in case of hyperthyroidism."}],"type":"dp"}
{"_id":"annales-2020-dp-13-qi-6","context":"You see in consultation a 57-year-old patient who suffers from epigastric pain progressing by attacks, which lasts several days and is accompanied by nausea. For the last 6 months, these seizures initially recurred once a month. They have now become fortnightly and the patient is forced to restrict his diet because of nausea. There is a progressive weight loss of 7 kg in two years. The patient measures 1m82 and weighs 66 kg. The patient has been an excessive consumer of wine since his military service (one bottle a day) and beer (2 to 3 per day) and has smoked a pack a day since the age of 25. For 6 months this alcohol consumption has been reduced.","enonce":"The stool is described by the patient as clear, putty, very foul-smelling and floating. An endoscopic ultrasound of the bile ducts and pancreas, performed secondarily, shows that the pancreatic obstacle is related to fibrosis. There is no lithiasis of the main bile duct. The patient suffers daily from epigastric pain that is relieved only by morphine analgesics. He decreased his beer consumption. There has been an additional weight loss of 2 kg over the past month. What is (are) the factor(s) promoting this weight loss?","item":"annales-2020-dp-13","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Exocrine pancreatic insufficiency","justification":"Malabsorption."},{"idx":1,"correct":true,"proposition":"Taking morphine","justification":"Morphine-induced nausea\/vomiting may contribute to weight loss."},{"idx":2,"correct":true,"proposition":"Pancreatic pain","justification":"Anorexia."},{"idx":3,"correct":true,"proposition":"Decreased beer consumption","justification":""},{"idx":4,"correct":true,"proposition":"Cholestasis","justification":""}],"type":"dp"}
{"_id":"annales-2020-dp-13-qi-7","context":"You see in consultation a 57-year-old patient who suffers from epigastric pain progressing by attacks, which lasts several days and is accompanied by nausea. For the last 6 months, these seizures initially recurred once a month. They have now become fortnightly and the patient is forced to restrict his diet because of nausea. There is a progressive weight loss of 7 kg in two years. The patient measures 1m82 and weighs 66 kg. The patient has been an excessive consumer of wine since his military service (one bottle a day) and beer (2 to 3 per day) and has smoked a pack a day since the age of 25. For 6 months this alcohol consumption has been reduced.","enonce":"Given this chronic alcoholic pancreatitis, a decrease in daily alcohol consumption of 9 to 3 units was negotiated. What decrease in daily calorie intake corresponds?","item":"annales-2020-dp-13","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"100kcal","justification":""},{"idx":1,"correct":false,"proposition":"200kcal","justification":""},{"idx":2,"correct":false,"proposition":"300kcal","justification":""},{"idx":3,"correct":true,"proposition":"400kcal"},{"idx":4,"correct":false,"proposition":"500kcal","justification":""}],"type":"dp"}
{"_id":"annales-2020-dp-13-qi-8","context":"You see in consultation a 57-year-old patient who suffers from epigastric pain progressing by attacks, which lasts several days and is accompanied by nausea. For the last 6 months, these seizures initially recurred once a month. They have now become fortnightly and the patient is forced to restrict his diet because of nausea. There is a progressive weight loss of 7 kg in two years. The patient measures 1m82 and weighs 66 kg. The patient has been an excessive consumer of wine since his military service (one bottle a day) and beer (2 to 3 per day) and has smoked a pack a day since the age of 25. For 6 months this alcohol consumption has been reduced.","enonce":"The patient reports, in addition to the weight loss occurring for several years, nocturnal urination, the frequency of which is increasing. His fasting blood glucose is 2.2 g\/L (12 mmol\/L). The rest of the balance sheet shows: \n\n- Ferritinemia 480 μg\/L (N: 30-280) \n\n- Albuminemia 27 g\/L \n\n- Triglycerides 0.45 g\/L (N: 0.7-1.6) \n\n- LDLc 0.55 g\/ (N: 0.6-1.6) \n\n- HDLc 0.25 g\/L (N: 0.45-0.8) \n\n- Fibrinogen 2.5 g\/L (N: 2.2-3.8) \n\n- V factor 65% (N: 65-100). \n\nHis urine strip shows: proteins - ; glucose +++; acetone traces; red blood cells -; Leukocytes-; Nitrite-. \n\nAbout its metabolic situation, what is the preferred statement?","item":"annales-2020-dp-13","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"This is secondary diabetes","justification":""},{"idx":1,"correct":false,"proposition":"It is an autoimmune type I diabetes","justification":""},{"idx":2,"correct":false,"proposition":"It is not possible to establish the diagnosis of diabetes on the basis of current evidence","justification":""},{"idx":3,"correct":false,"proposition":"This is type II diabetes","justification":""},{"idx":4,"correct":false,"proposition":"It is idiopathic type I diabetes","justification":""}],"type":"dp"}
{"_id":"annales-2020-dp-13-qi-9","context":"You see in consultation a 57-year-old patient who suffers from epigastric pain progressing by attacks, which lasts several days and is accompanied by nausea. For the last 6 months, these seizures initially recurred once a month. They have now become fortnightly and the patient is forced to restrict his diet because of nausea. There is a progressive weight loss of 7 kg in two years. The patient measures 1m82 and weighs 66 kg. The patient has been an excessive consumer of wine since his military service (one bottle a day) and beer (2 to 3 per day) and has smoked a pack a day since the age of 25. For 6 months this alcohol consumption has been reduced.","enonce":"Its HbA1c is dosed at 8.6%. You have chosen insulin therapy. Given your HbA1c goals, what factor(s) should you consider when choosing the option between a bolus basal regimen and a slow insulin regimen (simplified insulin therapy)? ","item":"annales-2020-dp-13","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Effective nature of partial alcohol withdrawal","justification":""},{"idx":1,"correct":true,"proposition":"Supportive social\/family environment","justification":""},{"idx":2,"correct":true,"proposition":"Therapeutic alliance of the patient","justification":""},{"idx":3,"correct":false,"proposition":"Presence of renal impairment with an estimated glomerular filtration rate of 70 ml\/","justification":""},{"idx":3,"correct":false,"proposition":"Presence of anti-GAD\/IA2 autoantibodies","justification":""}],"type":"dp"}
{"_id":"annales-2020-dp-13-qi-10","context":"You see in consultation a 57-year-old patient who suffers from epigastric pain progressing by attacks, which lasts several days and is accompanied by nausea. For the last 6 months, these seizures initially recurred once a month. They have now become fortnightly and the patient is forced to restrict his diet because of nausea. There is a progressive weight loss of 7 kg in two years. The patient measures 1m82 and weighs 66 kg. The patient has been an excessive consumer of wine since his military service (one bottle a day) and beer (2 to 3 per day) and has smoked a pack a day since the age of 25. For 6 months this alcohol consumption has been reduced.","enonce":"In this context of chronic pancreatitis, what treatment(s) or complementary measure(s) should be added in addition to its low-fat diet:","item":"annales-2020-dp-13","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Vitamin k","justification":"ADEK vitamins"},{"idx":1,"correct":true,"proposition":"Smoking cessation","justification":""},{"idx":2,"correct":false,"proposition":"Vitamin B12","justification":""},{"idx":3,"correct":true,"proposition":"Pancreatic extracts at every meal","justification":""},{"idx":4,"correct":false,"proposition":"Iron","justification":""}],"type":"dp"}
{"_id":"annales-2020-dp-13-qi-11","context":"You see in consultation a 57-year-old patient who suffers from epigastric pain progressing by attacks, which lasts several days and is accompanied by nausea. For the last 6 months, these seizures initially recurred once a month. They have now become fortnightly and the patient is forced to restrict his diet because of nausea. There is a progressive weight loss of 7 kg in two years. The patient measures 1m82 and weighs 66 kg. The patient has been an excessive consumer of wine since his military service (one bottle a day) and beer (2 to 3 per day) and has smoked a pack a day since the age of 25. For 6 months this alcohol consumption has been reduced.","enonce":"The patient, motivated, managed his bolus basal regimen with the help of continuous glucose recording and quit smoking. He complains of 6 moderate hypoglycemia weekly badly felt and, over the last month, two episodes of quasi-coma that required a third person for his rejuvenation. Which factor(s) are likely to increase the hypoglycemic risk in him:","item":"annales-2020-dp-13","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A resumption of smoking","justification":"Not related to hypoglycemia"},{"idx":1,"correct":true,"proposition":"A revival of alcoholism","justification":""},{"idx":2,"correct":true,"proposition":"Loss of function of alpha cells","justification":""},{"idx":3,"correct":true,"proposition":"The presence of gastroparesis","justification":""},{"idx":4,"correct":false,"proposition":"Non-compliance with pancreatic extracts","justification":"Not related to hypoglycemia"}],"type":"dp"}
{"_id":"annales-2020-dp-13-qi-12","context":"You see in consultation a 57-year-old patient who suffers from epigastric pain progressing by attacks, which lasts several days and is accompanied by nausea. For the last 6 months, these seizures initially recurred once a month. They have now become fortnightly and the patient is forced to restrict his diet because of nausea. There is a progressive weight loss of 7 kg in two years. The patient measures 1m82 and weighs 66 kg. The patient has been an excessive consumer of wine since his military service (one bottle a day) and beer (2 to 3 per day) and has smoked a pack a day since the age of 25. For 6 months this alcohol consumption has been reduced.","enonce":"Its one-week glycemic record shows the following profile about 3 representative days.\nWhich therapeutic adaptation do you think is the most relevant? (only one answer expected)","item":"annales-2020-dp-13","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Reduction of glargine dose in the evening","justification":"This would allow you to start the day a little higher. Since the morning level and the one to which the patient falls back after taking rapid insulin, this should solve his hypoglycemia 😊 problems"},{"idx":1,"correct":false,"proposition":"Reduction of the insulin dose of breakfast","justification":""},{"idx":2,"correct":false,"proposition":"Moving glargine injection from evening to morning","justification":""},{"idx":3,"correct":false,"proposition":"No therapeutic modification","justification":""},{"idx":4,"correct":false,"proposition":"Slow sugar snack at 10 p.m.","justification":""}],"type":"dp"}
{"_id":"annales-2020-dp-13-qi-13","context":"You see in consultation a 57-year-old patient who suffers from epigastric pain progressing by attacks, which lasts several days and is accompanied by nausea. For the last 6 months, these seizures initially recurred once a month. They have now become fortnightly and the patient is forced to restrict his diet because of nausea. There is a progressive weight loss of 7 kg in two years. The patient measures 1m82 and weighs 66 kg. The patient has been an excessive consumer of wine since his military service (one bottle a day) and beer (2 to 3 per day) and has smoked a pack a day since the age of 25. For 6 months this alcohol consumption has been reduced.","enonce":"As a result of hypoglycemia with loss of consciousness, he fell and complained of acute low back pain leading to the discovery of a wedge-shaped L1 fracture-settlement.\nWhich factor(s) contributed to his documented osteoporosis during two-photon absorptiometry?","item":"annales-2020-dp-13","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Chronic alcohol poisoning","justification":""},{"idx":1,"correct":false,"proposition":"Hyperparathyroidism secondary to malabsorption","justification":""},{"idx":2,"correct":true,"proposition":"Diabetes"},{"idx":3,"correct":false,"proposition":"Folate deficiency"},{"idx":4,"correct":true,"proposition":"Smoking"}],"type":"dp"}
{"_id":"annales-2022-dp-11-qi-1","context":"A 71-year-old man is referred to the emergency room for right lower back pain, deterioration of the general condition with nausea and vomiting evolving for 72 hours. His history is marked by: Type II diabetes evolving for 15 years treated with metformin 3 g \/ d \/ High blood pressure treated with irbersartan 300 mg \/ d and hydrochlorothiazide and well controlled under treatment for several years \/ An episode of left renal colic 2 years ago with spontaneous elimination of the stone \/ A smoking weaned for 5 years evaluated at 30 pack-years \/ Obesity with a weight of 90kg for 1m70. He took ibuprofen for lumbago for 48 hours a few days ago which he stopped due to the occurrence of epigastralgia.","enonce":" What are the elements of the clinical examination to assess the initial severity? (one or more correct answers)","item":"annales-2022-dp-11","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Temperature measurement","justification":""},{"idx":1,"correct":false,"proposition":"Assessment of pain intensity","justification":""},{"idx":2,"correct":true,"proposition":"Taking blood pressure","justification":""},{"idx":3,"correct":false,"proposition":"Lumbar contact tracing","justification":""},{"idx":4,"correct":true,"proposition":"Evaluation of diuresis","justification":""}],"type":"dp"}
{"_id":"annales-2022-dp-11-qi-2","context":"A 71-year-old man is referred to the emergency room for right lower back pain, deterioration of the general condition with nausea and vomiting evolving for 72 hours. His history is marked by: Type II diabetes evolving for 15 years treated with metformin 3 g \/ d \/ High blood pressure treated with irbersartan 300 mg \/ d and hydrochlorothiazide and well controlled under treatment for several years \/ An episode of left renal colic 2 years ago with spontaneous elimination of the stone \/ A smoking weaned for 5 years evaluated at 30 pack-years \/ Obesity with a weight of 90kg for 1m70. He took ibuprofen for lumbago for 48 hours a few days ago which he stopped due to the occurrence of epigastralgia.","enonce":" What are the important elements to collect to specifically orient a urological cause? (one or more correct answers)","item":"annales-2022-dp-11","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Irradiation of pain to the external genitalia","justification":""},{"idx":1,"correct":false,"proposition":"Pain relieved by vomiting","justification":""},{"idx":2,"correct":false,"proposition":"Pain relieved by diet","justification":""},{"idx":3,"correct":false,"proposition":"Pain relieved by anteflexion","justification":""},{"idx":4,"correct":false,"proposition":"Sudden installation pain","justification":""}],"type":"dp"}
{"_id":"annales-2022-dp-11-qi-3","context":"A 71-year-old man is referred to the emergency room for right lower back pain, deterioration of the general condition with nausea and vomiting evolving for 72 hours. His history is marked by: Type II diabetes evolving for 15 years treated with metformin 3 g \/ d \/ High blood pressure treated with irbersartan 300 mg \/ d and hydrochlorothiazide and well controlled under treatment for several years \/ An episode of left renal colic 2 years ago with spontaneous elimination of the stone \/ A smoking weaned for 5 years evaluated at 30 pack-years \/ Obesity with a weight of 90kg for 1m70. He took ibuprofen for lumbago for 48 hours a few days ago which he stopped due to the occurrence of epigastralgia.","enonce":" The clinical examination finds: temperature 38.2°C, blood pressure 100\/45 mmHg, heart rate 120\/min. The patient is agitated. He has no pollakiurieni from urination burn. He says he hasn't urinated in 12 hours. He has a lumbar pain predominant on the right without lumbar contact, rapid installation, without irradiation to the genito-external organs. He complains of a transit stoppage. The patient is not icteric. The abdomen is flexible, hydro airy noises are perceived. The urine strip reveals: 2 leukocyte crosses, no blood, 1 proteinuria cross, absence of ketonuriaAmong the following proposals, what are the exact proposals? (one or more correct answers)","item":"annales-2022-dp-11","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"The absence of pollakiuria does not eliminate a urinary tract infection","justification":""},{"idx":1,"correct":true,"proposition":"The absence of burning urination does not eliminate a urinary tract infection","justification":""},{"idx":2,"correct":true,"proposition":"The absence of hematuria does not eliminate a urological origin of this pain","justification":""},{"idx":3,"correct":true,"proposition":"The absence of irradiation does not eliminate a urinary origin","justification":""},{"idx":4,"correct":true,"proposition":"The absence of jaundice does not eliminate a hepatic cause","justification":""}],"type":"dp"}
{"_id":"annales-2022-dp-11-qi-4","context":"A 71-year-old man is referred to the emergency room for right lower back pain, deterioration of the general condition with nausea and vomiting evolving for 72 hours. His history is marked by: Type II diabetes evolving for 15 years treated with metformin 3 g \/ d \/ High blood pressure treated with irbersartan 300 mg \/ d and hydrochlorothiazide and well controlled under treatment for several years \/ An episode of left renal colic 2 years ago with spontaneous elimination of the stone \/ A smoking weaned for 5 years evaluated at 30 pack-years \/ Obesity with a weight of 90kg for 1m70. He took ibuprofen for lumbago for 48 hours a few days ago which he stopped due to the occurrence of epigastralgia.","enonce":" What exams do you perform as a first-line treatment? (one or more correct answers)","item":"annales-2022-dp-11","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Blood count","justification":""},{"idx":1,"correct":true,"proposition":"Blood ionogram with serum creatinine","justification":""},{"idx":2,"correct":false,"proposition":"D-Dimers","justification":""},{"idx":3,"correct":false,"proposition":"Total PSA","justification":""},{"idx":4,"correct":true,"proposition":"ECBU","justification":""}],"type":"dp"}
{"_id":"annales-2022-dp-11-qi-5","context":"A 71-year-old man is referred to the emergency room for right lower back pain, deterioration of the general condition with nausea and vomiting evolving for 72 hours. His history is marked by: Type II diabetes evolving for 15 years treated with metformin 3 g \/ d \/ High blood pressure treated with irbersartan 300 mg \/ d and hydrochlorothiazide and well controlled under treatment for several years \/ An episode of left renal colic 2 years ago with spontaneous elimination of the stone \/ A smoking weaned for 5 years evaluated at 30 pack-years \/ Obesity with a weight of 90kg for 1m70. He took ibuprofen for lumbago for 48 hours a few days ago which he stopped due to the occurrence of epigastralgia.","enonce":" What are the 3 most likely diagnoses in front of this table?","item":"annales-2022-dp-11","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Sigmoiditis","justification":""},{"idx":1,"correct":true,"proposition":"Acute pyelonephritis","justification":""},{"idx":2,"correct":false,"proposition":"Acute tubular necrosis","justification":""},{"idx":3,"correct":true,"proposition":"Febrile renal colic","justification":""},{"idx":4,"correct":true,"proposition":"Renal infarction","justification":""}],"type":"dp"}
{"_id":"annales-2022-dp-11-qi-6","context":"A 71-year-old man is referred to the emergency room for right lower back pain, deterioration of the general condition with nausea and vomiting evolving for 72 hours. His history is marked by: Type II diabetes evolving for 15 years treated with metformin 3 g \/ d \/ High blood pressure treated with irbersartan 300 mg \/ d and hydrochlorothiazide and well controlled under treatment for several years \/ An episode of left renal colic 2 years ago with spontaneous elimination of the stone \/ A smoking weaned for 5 years evaluated at 30 pack-years \/ Obesity with a weight of 90kg for 1m70. He took ibuprofen for lumbago for 48 hours a few days ago which he stopped due to the occurrence of epigastralgia.","enonce":" The assessment you have carried out shows: Blood biochemistry: creatinine 500 micromol\/L, urea 25 mmol\/L, potassium 4.9 mmol\/L, sodium 138 mmol\/L, bicarbonate 18 mmol\/L, chlorine 99 mmol\/L, blood glucose 12 mmol\/L, CRP 120 mg\/L.ECBU: leukocytes 20\/mm 3, red blood cells 10\/mm 3, negative direct examination and culture in progress. Urine biochemistry on sample: sodium 50 mmol\/l, potassium 25 mmol\/L, urinary urea 150 mmol\/l, creatinine 3 mmol\/l, proteinuria 0.2 g\/l. (one or more correct answers)","item":"annales-2022-dp-11","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"The anion hole is at 16 mmol\/L (excluding potassium)","justification":""},{"idx":1,"correct":true,"proposition":"The anionic hole is raised","justification":""},{"idx":2,"correct":false,"proposition":"The anion hole is compatible with a loss of bicarbonates in the urine","justification":""},{"idx":3,"correct":true,"proposition":"This assessment needs to be supplemented by a lactate dosage","justification":""},{"idx":4,"correct":true,"proposition":"This assessment needs to be supplemented by a dosage of ketone bodies in the blood","justification":""}],"type":"dp"}
{"_id":"annales-2022-dp-11-qi-7","context":"A 71-year-old man is referred to the emergency room for right lower back pain, deterioration of the general condition with nausea and vomiting evolving for 72 hours. His history is marked by: Type II diabetes evolving for 15 years treated with metformin 3 g \/ d \/ High blood pressure treated with irbersartan 300 mg \/ d and hydrochlorothiazide and well controlled under treatment for several years \/ An episode of left renal colic 2 years ago with spontaneous elimination of the stone \/ A smoking weaned for 5 years evaluated at 30 pack-years \/ Obesity with a weight of 90kg for 1m70. He took ibuprofen for lumbago for 48 hours a few days ago which he stopped due to the occurrence of epigastralgia.","enonce":" An arterial blood gas shows: pH 7.35, PaCO 2 37 mmHg, PaO 2 75 mmHg, alkaline reserve 18 mmol\/L, lactic acid 3 mmol\/L. What is your initial management? (one or more correct answers)","item":"annales-2022-dp-11","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Alkalinization by sodium bicarbonate 84\/1000","justification":""},{"idx":1,"correct":true,"proposition":"Discontinuation of metformin","justification":""},{"idx":2,"correct":true,"proposition":"Discontinuation of irbesartan","justification":""},{"idx":3,"correct":true,"proposition":"Vascular filling by NaCl solute 0.9%","justification":""},{"idx":4,"correct":false,"proposition":"Introduction of loop diuretic to revive diuresis","justification":""}],"type":"dp"}
{"_id":"annales-2022-dp-11-qi-8","context":"A 71-year-old man is referred to the emergency room for right lower back pain, deterioration of the general condition with nausea and vomiting evolving for 72 hours. His history is marked by: Type II diabetes evolving for 15 years treated with metformin 3 g \/ d \/ High blood pressure treated with irbersartan 300 mg \/ d and hydrochlorothiazide and well controlled under treatment for several years \/ An episode of left renal colic 2 years ago with spontaneous elimination of the stone \/ A smoking weaned for 5 years evaluated at 30 pack-years \/ Obesity with a weight of 90kg for 1m70. He took ibuprofen for lumbago for 48 hours a few days ago which he stopped due to the occurrence of epigastralgia.","enonce":" Despite vascular filling, oliguria and renal failure persist. What is the main cause that may explain the acute renal failure of this patient?","item":"annales-2022-dp-11","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Acute tubular necrosis","justification":""},{"idx":1,"correct":false,"proposition":"Functional acute renal failure","justification":""},{"idx":2,"correct":false,"proposition":"Acute tubular nephritis with NSAIDs","justification":""},{"idx":3,"correct":false,"proposition":"Acute obstructive pyelonephritis","justification":""},{"idx":4,"correct":false,"proposition":"Papillary necrosis","justification":""}],"type":"dp"}
{"_id":"annales-2022-dp-11-qi-9","context":"A 71-year-old man is referred to the emergency room for right lower back pain, deterioration of the general condition with nausea and vomiting evolving for 72 hours. His history is marked by: Type II diabetes evolving for 15 years treated with metformin 3 g \/ d \/ High blood pressure treated with irbersartan 300 mg \/ d and hydrochlorothiazide and well controlled under treatment for several years \/ An episode of left renal colic 2 years ago with spontaneous elimination of the stone \/ A smoking weaned for 5 years evaluated at 30 pack-years \/ Obesity with a weight of 90kg for 1m70. He took ibuprofen for lumbago for 48 hours a few days ago which he stopped due to the occurrence of epigastralgia.","enonce":" What is decisive for emergency care?","item":"annales-2022-dp-11","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Presence of eosinophilia","justification":""},{"idx":1,"correct":true,"proposition":"Renal vesicogram ultrasound","justification":""},{"idx":2,"correct":false,"proposition":"Presence of hepatic cytolysis","justification":""},{"idx":3,"correct":false,"proposition":"Renal MRI","justification":""},{"idx":4,"correct":false,"proposition":"Uroscanner","justification":""}],"type":"dp"}
{"_id":"annales-2022-dp-11-qi-10","context":"A 71-year-old man is referred to the emergency room for right lower back pain, deterioration of the general condition with nausea and vomiting evolving for 72 hours. His history is marked by: Type II diabetes evolving for 15 years treated with metformin 3 g \/ d \/ High blood pressure treated with irbersartan 300 mg \/ d and hydrochlorothiazide and well controlled under treatment for several years \/ An episode of left renal colic 2 years ago with spontaneous elimination of the stone \/ A smoking weaned for 5 years evaluated at 30 pack-years \/ Obesity with a weight of 90kg for 1m70. He took ibuprofen for lumbago for 48 hours a few days ago which he stopped due to the occurrence of epigastralgia.","enonce":" The assessment you have made shows: blood count: hemoglobin 12 g \/ dL; leukocytes 12 G\/L, neutrophils 9 G\/L, polynuclear eosinophils 0.4 G\/L, platelets 500 G\/L. ECBU is sterile. AST at twice normal and ALT in normal values. Abdominal and renal ultrasound: right kidney 110 mm, left kidney 120 mm, absence of pyelocalicial dilation, empty bladder, normal sized liver, non-stretched gallbladder and alithiasia. What are the exact proposals? (one or more correct answers)","item":"annales-2022-dp-11","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"The presence of urolithiasis can be eliminated","justification":""},{"idx":1,"correct":true,"proposition":"Pyelonephritis can be ruled out","justification":""},{"idx":2,"correct":true,"proposition":"Immunoallergic nephritis is possible","justification":""},{"idx":3,"correct":false,"proposition":"Acute cholecystitis is likely","justification":""},{"idx":4,"correct":true,"proposition":"Renal failure is probably acute","justification":""}],"type":"dp"}
{"_id":"annales-2022-dp-11-qi-11","context":"A 71-year-old man is referred to the emergency room for right lower back pain, deterioration of the general condition with nausea and vomiting evolving for 72 hours. His history is marked by: Type II diabetes evolving for 15 years treated with metformin 3 g \/ d \/ High blood pressure treated with irbersartan 300 mg \/ d and hydrochlorothiazide and well controlled under treatment for several years \/ An episode of left renal colic 2 years ago with spontaneous elimination of the stone \/ A smoking weaned for 5 years evaluated at 30 pack-years \/ Obesity with a weight of 90kg for 1m70. He took ibuprofen for lumbago for 48 hours a few days ago which he stopped due to the occurrence of epigastralgia.","enonce":" The electrocardiogram performed is as follows: What are the exact proposals? (one or more correct answers)","item":"annales-2022-dp-11","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Supraventricular tachycardia","justification":""},{"idx":1,"correct":false,"proposition":"Right axis of QRS","justification":""},{"idx":2,"correct":true,"proposition":"Atrial fibrillation","justification":""},{"idx":3,"correct":false,"proposition":"Ventricular tachycardia","justification":""},{"idx":4,"correct":false,"proposition":"Ear fluttering","justification":""}],"type":"dp"}
{"_id":"annales-2022-dp-11-qi-12","context":"A 71-year-old man is referred to the emergency room for right lower back pain, deterioration of the general condition with nausea and vomiting evolving for 72 hours. His history is marked by: Type II diabetes evolving for 15 years treated with metformin 3 g \/ d \/ High blood pressure treated with irbersartan 300 mg \/ d and hydrochlorothiazide and well controlled under treatment for several years \/ An episode of left renal colic 2 years ago with spontaneous elimination of the stone \/ A smoking weaned for 5 years evaluated at 30 pack-years \/ Obesity with a weight of 90kg for 1m70. He took ibuprofen for lumbago for 48 hours a few days ago which he stopped due to the occurrence of epigastralgia.","enonce":" The ECG shows atrial fibrillation with tachycardia. With the initial treatment, renal function partially improves with serum creatinine stabilizing at 140 μmol\/l (DFG CKD-EPI 43 ml\/min\/1.73m2). Despite the analgesic treatment, the lower back pain remains intense. His blood pressure is 160\/80 mmHg, his heart rate is 120\/min and his temperature is 38.1°C.  You have recovered a serum creatinine of the patient, performed 2 months ago, which was 90 μmol \/ L (DFG CKD-EPI 74 mL \/ min \/ 1.73 m2). To advance in the diagnosis of this persistent acute renal failure and its clinical picture, what tests could you request? (one or more correct answers)","item":"annales-2022-dp-11","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Abdominopelvic CT scan with injection","justification":""},{"idx":1,"correct":true,"proposition":"LDH determination","justification":""},{"idx":2,"correct":false,"proposition":"Renal Doppler ultrasound","justification":""},{"idx":3,"correct":true,"proposition":"Arteriography of the renal arteries","justification":""},{"idx":4,"correct":false,"proposition":"Puncture kidney biopsy","justification":""}],"type":"dp"}
{"_id":"annales-2022-dp-11-qi-13","context":"A 71-year-old man is referred to the emergency room for right lower back pain, deterioration of the general condition with nausea and vomiting evolving for 72 hours. His history is marked by: Type II diabetes evolving for 15 years treated with metformin 3 g \/ d \/ High blood pressure treated with irbersartan 300 mg \/ d and hydrochlorothiazide and well controlled under treatment for several years \/ An episode of left renal colic 2 years ago with spontaneous elimination of the stone \/ A smoking weaned for 5 years evaluated at 30 pack-years \/ Obesity with a weight of 90kg for 1m70. He took ibuprofen for lumbago for 48 hours a few days ago which he stopped due to the occurrence of epigastralgia.","enonce":" A pelvic abdomino scan was performed: What are the exact proposals? (one or more correct answers)","item":"annales-2022-dp-11","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"examination shows kidney cysts of the right kidney","justification":""},{"idx":1,"correct":false,"proposition":"Examination shows lithiasis enclosed in the right kidney","justification":""},{"idx":2,"correct":false,"proposition":"the right pyelocalcial cavities are dilated","justification":""},{"idx":3,"correct":true,"proposition":"examination shows an area of hypoperfusion of the right kidney","justification":""},{"idx":4,"correct":true,"proposition":"It is a CT scan injected at arterial time","justification":""}],"type":"dp"}
{"_id":"annales-2022-dp-11-qi-14","context":"A 71-year-old man is referred to the emergency room for right lower back pain, deterioration of the general condition with nausea and vomiting evolving for 72 hours. His history is marked by: Type II diabetes evolving for 15 years treated with metformin 3 g \/ d \/ High blood pressure treated with irbersartan 300 mg \/ d and hydrochlorothiazide and well controlled under treatment for several years \/ An episode of left renal colic 2 years ago with spontaneous elimination of the stone \/ A smoking weaned for 5 years evaluated at 30 pack-years \/ Obesity with a weight of 90kg for 1m70. He took ibuprofen for lumbago for 48 hours a few days ago which he stopped due to the occurrence of epigastralgia.","enonce":" The assessment is compatible with a renal infarction predominant on the right on atrial fibrillation. What assessment is needed in the first place? (one or more correct answers)","item":"annales-2022-dp-11","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"PTH assay","justification":""},{"idx":1,"correct":true,"proposition":"TSH test","justification":""},{"idx":2,"correct":true,"proposition":"Cardiac ultrasound","justification":""},{"idx":3,"correct":false,"proposition":"Coro scanner","justification":""},{"idx":4,"correct":false,"proposition":"Holter ECG","justification":""}],"type":"dp"}
{"_id":"annales-2022-dp-11-qi-15","context":"A 71-year-old man is referred to the emergency room for right lower back pain, deterioration of the general condition with nausea and vomiting evolving for 72 hours. His history is marked by: Type II diabetes evolving for 15 years treated with metformin 3 g \/ d \/ High blood pressure treated with irbersartan 300 mg \/ d and hydrochlorothiazide and well controlled under treatment for several years \/ An episode of left renal colic 2 years ago with spontaneous elimination of the stone \/ A smoking weaned for 5 years evaluated at 30 pack-years \/ Obesity with a weight of 90kg for 1m70. He took ibuprofen for lumbago for 48 hours a few days ago which he stopped due to the occurrence of epigastralgia.","enonce":" What care would be relevant in the immediate future? (one or more correct answers)","item":"annales-2022-dp-11","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Antiplatelet","justification":""},{"idx":1,"correct":false,"proposition":"Preventive anticoagulation","justification":""},{"idx":2,"correct":true,"proposition":"Effective anticoagulation","justification":""},{"idx":3,"correct":false,"proposition":"Electrical cardioversion","justification":""},{"idx":4,"correct":false,"proposition":"Drug cardioversion","justification":""}],"type":"dp"}
{"_id":"annales-2022-dp-17-qi-1","context":"You receive in consultation a woman of 52 years, second gesture, nulliparous, not taking contraception. Its body mass index is 42 kg\/m2. She has high blood pressure well controlled by perindopril, amlodipine and indapamide. She also has hypothyroidism of undetermined etiology requiring long-term thyroid hormone intake and also well-balanced type 2 diabetes under diet alone. She had surgery for a total left hip replacement 4 years ago. She has a family history of colon cancer in her father, from whom he died at the age of 59. She also reported breast cancer in her mother at the age of 47 and her maternal aunt at the age of 60.","enonce":" This woman has not had a menstrual period for a year and a half. She complains of crippling hot flashes. She says she is exasperated and can no longer stand her professional activity. After discussing it with her friends, she wants \"a blood test\" to confirm that she is well menopausal. If she is really menopausal, what are the expected plasma hormonal changes? (one or more correct answers)","item":"annales-2022-dp-17","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"increased progesterone levels","justification":""},{"idx":1,"correct":true,"proposition":"an increase in FSH (follicle stimulating hormone) levels","justification":""},{"idx":2,"correct":false,"proposition":"an increase in estradiol levels","justification":""},{"idx":3,"correct":true,"proposition":"an increase in LH (luteinizing hormone) levels","justification":""},{"idx":4,"correct":false,"proposition":"increased androgen levels","justification":""}],"type":"dp"}
{"_id":"annales-2022-dp-17-qi-2","context":"You receive in consultation a woman of 52 years, second gesture, nulliparous, not taking contraception. Its body mass index is 42 kg\/m2. She has high blood pressure well controlled by perindopril, amlodipine and indapamide. She also has hypothyroidism of undetermined etiology requiring long-term thyroid hormone intake and also well-balanced type 2 diabetes under diet alone. She had surgery for a total left hip replacement 4 years ago. She has a family history of colon cancer in her father, from whom he died at the age of 59. She also reported breast cancer in her mother at the age of 47 and her maternal aunt at the age of 60.","enonce":" This woman is indeed menopausal. She wants hormone replacement therapy to relieve her hot flashes. You discuss this treatment with her. What are the exact claims? (one or more correct answers)","item":"annales-2022-dp-17","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"estrogen can be administered dermally","justification":""},{"idx":1,"correct":false,"proposition":"Estrogen therapy has no impact on lipid metabolism","justification":""},{"idx":2,"correct":true,"proposition":"a mammogram is required","justification":""},{"idx":3,"correct":true,"proposition":"Progestogen therapy should be combined with estrogen therapy","justification":""},{"idx":4,"correct":true,"proposition":"Estrogen therapy may limit vaginal atrophy","justification":""}],"type":"dp"}
{"_id":"annales-2022-dp-17-qi-3","context":"You receive in consultation a woman of 52 years, second gesture, nulliparous, not taking contraception. Its body mass index is 42 kg\/m2. She has high blood pressure well controlled by perindopril, amlodipine and indapamide. She also has hypothyroidism of undetermined etiology requiring long-term thyroid hormone intake and also well-balanced type 2 diabetes under diet alone. She had surgery for a total left hip replacement 4 years ago. She has a family history of colon cancer in her father, from whom he died at the age of 59. She also reported breast cancer in her mother at the age of 47 and her maternal aunt at the age of 60.","enonce":" The complete clinical examination during the consultation is considered normal, apart from obesity. You prescribe a laboratory work:Glycated hemoglobin (HbA1c) 7.9%Hemoglobin 11.2 g\/dL (N: 12 - 16 g\/dL)GFR (glomerular filtration rate) 55 mL\/min (N > 60 mL\/min)Creatinine 115 μmol\/L (N: 35-90 μmol\/L)Plasma urea 7 mmol\/L (N: 2.5 - 7 mmol\/L)Protein 63 g\/L (N: 60-80 g\/L)Total cholesterol 3 g\/L (N:  1.35 - 2.5 g\/L)Triglycerides 3.5 g\/L (N: 0.35 - 1.4 g\/L) ","item":"annales-2022-dp-17","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"his diabetes is balanced","justification":""},{"idx":1,"correct":true,"proposition":"has mixed dyslipidemia","justification":""},{"idx":2,"correct":false,"proposition":"has intracellular dehydration","justification":""},{"idx":3,"correct":true,"proposition":"  his kidney failure is probably chronic","justification":""},{"idx":4,"correct":false,"proposition":"Anemia is explained by menopause","justification":""}],"type":"dp"}
{"_id":"annales-2022-dp-17-qi-4","context":"You receive in consultation a woman of 52 years, second gesture, nulliparous, not taking contraception. Its body mass index is 42 kg\/m2. She has high blood pressure well controlled by perindopril, amlodipine and indapamide. She also has hypothyroidism of undetermined etiology requiring long-term thyroid hormone intake and also well-balanced type 2 diabetes under diet alone. She had surgery for a total left hip replacement 4 years ago. She has a family history of colon cancer in her father, from whom he died at the age of 59. She also reported breast cancer in her mother at the age of 47 and her maternal aunt at the age of 60.","enonce":" Her diabetes is therefore poorly balanced, she has mixed dyslipidemia and chronic renal failure. In addition, she is afraid of having osteoporosis because she complains of pain in her right knee, without any notion of trauma. These pains have been progressing for several months, with worsening in recent days. They radiate little, occur at the end of the day and prevent the patient from sitting for a long time. In view of the clinical picture, you suspect right gonarthrosis. What additional tests do you prescribe as a first line? (one or more correct answers)","item":"annales-2022-dp-17","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"X-ray of the knees (face and profile)","justification":""},{"idx":1,"correct":false,"proposition":"bone scintigraphy","justification":""},{"idx":2,"correct":false,"proposition":"computed tomography (CT) scan of the knee","justification":""},{"idx":3,"correct":false,"proposition":"magnetic resonance imaging (MRI) of the right knee","justification":""},{"idx":4,"correct":false,"proposition":"ultrasound of the right knee","justification":""}],"type":"dp"}
{"_id":"annales-2022-dp-17-qi-5","context":"You receive in consultation a woman of 52 years, second gesture, nulliparous, not taking contraception. Its body mass index is 42 kg\/m2. She has high blood pressure well controlled by perindopril, amlodipine and indapamide. She also has hypothyroidism of undetermined etiology requiring long-term thyroid hormone intake and also well-balanced type 2 diabetes under diet alone. She had surgery for a total left hip replacement 4 years ago. She has a family history of colon cancer in her father, from whom he died at the age of 59. She also reported breast cancer in her mother at the age of 47 and her maternal aunt at the age of 60.","enonce":" Standard knee X-rays have been taken in your patient who suffers from gonalgia. What signs are found on these pictures of the right knee? (one or more correct answers)","item":"annales-2022-dp-17","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"osteophytes of the femoro-tibial medial compartment","justification":""},{"idx":1,"correct":false,"proposition":"chondrocalcinosis","justification":""},{"idx":2,"correct":false,"proposition":"subchondral bone erosions at the periphery of the joint","justification":""},{"idx":3,"correct":false,"proposition":"a stress fracture of the medial femoral condyle","justification":""},{"idx":4,"correct":true,"proposition":"pinching of medial femoro-tibial spacer","justification":""}],"type":"dp"}
{"_id":"annales-2022-dp-17-qi-6","context":"You receive in consultation a woman of 52 years, second gesture, nulliparous, not taking contraception. Its body mass index is 42 kg\/m2. She has high blood pressure well controlled by perindopril, amlodipine and indapamide. She also has hypothyroidism of undetermined etiology requiring long-term thyroid hormone intake and also well-balanced type 2 diabetes under diet alone. She had surgery for a total left hip replacement 4 years ago. She has a family history of colon cancer in her father, from whom he died at the age of 59. She also reported breast cancer in her mother at the age of 47 and her maternal aunt at the age of 60.","enonce":" Gonarthrosis is confirmed, what care can you offer? (one or more correct answers)","item":"annales-2022-dp-17","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Oral corticosteroid therapy","justification":""},{"idx":1,"correct":false,"proposition":"Oral nonsteroidal anti-inflammatory drug","justification":""},{"idx":2,"correct":true,"proposition":"Dietary management","justification":""},{"idx":3,"correct":true,"proposition":"Tier 1 analgesic","justification":""},{"idx":4,"correct":true,"proposition":"moderate physical activity outside of painful periods","justification":""}],"type":"dp"}
{"_id":"annales-2022-dp-17-qi-7","context":"You receive in consultation a woman of 52 years, second gesture, nulliparous, not taking contraception. Its body mass index is 42 kg\/m2. She has high blood pressure well controlled by perindopril, amlodipine and indapamide. She also has hypothyroidism of undetermined etiology requiring long-term thyroid hormone intake and also well-balanced type 2 diabetes under diet alone. She had surgery for a total left hip replacement 4 years ago. She has a family history of colon cancer in her father, from whom he died at the age of 59. She also reported breast cancer in her mother at the age of 47 and her maternal aunt at the age of 60.","enonce":" You encouraged her to have screening mammograms despite a senological examination considered normal. This examination reveals a 10 mm lesion, spiculated, localized in the inner quadrant (IIQ) of the right breast, classified ACR 5. A mammogram of the left breast is normal. Regarding complementary breast and axillary ultrasound, what are the signs suggestive of malignancy to look for? (one or more correct answers)","item":"annales-2022-dp-17","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"clear boundaries of the tumour located in the right infero-internal quadrant","justification":""},{"idx":1,"correct":true,"proposition":"the presence of a right axillary lymphadenopathy of 15 mm","justification":""},{"idx":2,"correct":false,"proposition":"posterior strengthening of the tumour located in the right inferointernal quadrant","justification":""},{"idx":3,"correct":true,"proposition":"a hypoechoic appearance of the tumour located in the right infero-internal quadrant","justification":""},{"idx":4,"correct":true,"proposition":"orientation of the tumor, not parallel to the cutaneous plane","justification":""}],"type":"dp"}
{"_id":"annales-2022-dp-17-qi-8","context":"You receive in consultation a woman of 52 years, second gesture, nulliparous, not taking contraception. Its body mass index is 42 kg\/m2. She has high blood pressure well controlled by perindopril, amlodipine and indapamide. She also has hypothyroidism of undetermined etiology requiring long-term thyroid hormone intake and also well-balanced type 2 diabetes under diet alone. She had surgery for a total left hip replacement 4 years ago. She has a family history of colon cancer in her father, from whom he died at the age of 59. She also reported breast cancer in her mother at the age of 47 and her maternal aunt at the age of 60.","enonce":" Breast ultrasound showed the existence of a hypoechoic tumor of 10 mm in the right infero-internal quadrant, poorly limited, with a large axenon parallel to the cutaneous plane and without associated axillary lymphadenopathy. What explorations do you prescribe? (one or more correct answers)","item":"annales-2022-dp-17","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Percutaneous biopsy samples","justification":""},{"idx":1,"correct":false,"proposition":"A positron emission tomography (PET CT) scan with 18 fluorodeoxy glucose","justification":""},{"idx":2,"correct":false,"proposition":"A plasma assay of the CA 15.3 marker","justification":""},{"idx":3,"correct":false,"proposition":"A thoraco-abdomino-pelvic CT scan","justification":""},{"idx":4,"correct":false,"proposition":"A brain scan","justification":""}],"type":"dp"}
{"_id":"annales-2022-dp-17-qi-9","context":"You receive in consultation a woman of 52 years, second gesture, nulliparous, not taking contraception. Its body mass index is 42 kg\/m2. She has high blood pressure well controlled by perindopril, amlodipine and indapamide. She also has hypothyroidism of undetermined etiology requiring long-term thyroid hormone intake and also well-balanced type 2 diabetes under diet alone. She had surgery for a total left hip replacement 4 years ago. She has a family history of colon cancer in her father, from whom he died at the age of 59. She also reported breast cancer in her mother at the age of 47 and her maternal aunt at the age of 60.","enonce":" The patient had microbiopsies of the lesion of the lower inner quadrant. Pathological results revealed invasive carcinoma of non-specific, grade II, estrogen receptors (ER): 20%, progesterone receptors (PR): 0%, HER2: negativeWhat treatments do you prescribe? (one or more correct answers)","item":"annales-2022-dp-17","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"neoadjuvant chemotherapy","justification":""},{"idx":1,"correct":false,"proposition":"trastuzumab","justification":""},{"idx":2,"correct":true,"proposition":"Right partial mastectomy (lumpectomy)","justification":""},{"idx":3,"correct":true,"proposition":"removal of the right axillary sentinel lymph node","justification":""},{"idx":4,"correct":false,"proposition":"Tamoxifen","justification":""}],"type":"dp"}
{"_id":"annales-2022-dp-17-qi-10","context":"You receive in consultation a woman of 52 years, second gesture, nulliparous, not taking contraception. Its body mass index is 42 kg\/m2. She has high blood pressure well controlled by perindopril, amlodipine and indapamide. She also has hypothyroidism of undetermined etiology requiring long-term thyroid hormone intake and also well-balanced type 2 diabetes under diet alone. She had surgery for a total left hip replacement 4 years ago. She has a family history of colon cancer in her father, from whom he died at the age of 59. She also reported breast cancer in her mother at the age of 47 and her maternal aunt at the age of 60.","enonce":" The patient had a right partial mastectomy with sentinel lymph node retrieval. The pathological results objectified a non-specific invasive mammary carcinoma of 8 mm of the infero-internal quadrant; ER (30%), PR (5%), HER2 negative, Ki 67=10% and an axillary sentinel lymph nodeunharmed. External beam radiation therapy was performed on the right breast. Treatment with anti-aromatase is prescribed. What are the exact statements about this adjuvant drug therapy? (one or more correct answers)","item":"annales-2022-dp-17","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"It is associated with an increased osteoporotic risk","justification":""},{"idx":1,"correct":false,"proposition":"It is associated with an increased thromboembolic risk","justification":""},{"idx":2,"correct":true,"proposition":"It is associated with an increased risk of ovarian cancer","justification":""},{"idx":3,"correct":true,"proposition":"It works by blocking the transformation of androgens into estrogens","justification":""},{"idx":4,"correct":false,"proposition":"it is to be continued for at least 5 years","justification":""}],"type":"dp"}
{"_id":"annales-2022-dp-17-qi-11","context":"You receive in consultation a woman of 52 years, second gesture, nulliparous, not taking contraception. Its body mass index is 42 kg\/m2. She has high blood pressure well controlled by perindopril, amlodipine and indapamide. She also has hypothyroidism of undetermined etiology requiring long-term thyroid hormone intake and also well-balanced type 2 diabetes under diet alone. She had surgery for a total left hip replacement 4 years ago. She has a family history of colon cancer in her father, from whom he died at the age of 59. She also reported breast cancer in her mother at the age of 47 and her maternal aunt at the age of 60.","enonce":" What will your annual monitoring include after the end of treatment for this cancer classified pT1bN0M0 and in the absence of any symptoms? (one or more correct answers)","item":"annales-2022-dp-17","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Abdominopelvic ultrasound","justification":""},{"idx":1,"correct":false,"proposition":"CA15.3 tumour marker assay","justification":""},{"idx":2,"correct":true,"proposition":"Clinical examination of the right partial mastectomy scar","justification":""},{"idx":3,"correct":true,"proposition":"Bilateral mammograms","justification":""},{"idx":4,"correct":false,"proposition":"bone scintigraphy","justification":""}],"type":"dp"}
{"_id":"annales-2022-dp-17-qi-12","context":"You receive in consultation a woman of 52 years, second gesture, nulliparous, not taking contraception. Its body mass index is 42 kg\/m2. She has high blood pressure well controlled by perindopril, amlodipine and indapamide. She also has hypothyroidism of undetermined etiology requiring long-term thyroid hormone intake and also well-balanced type 2 diabetes under diet alone. She had surgery for a total left hip replacement 4 years ago. She has a family history of colon cancer in her father, from whom he died at the age of 59. She also reported breast cancer in her mother at the age of 47 and her maternal aunt at the age of 60.","enonce":" This woman is suspected to have a genetic predisposition to cancer. What are the exact statements about an oncogenetic consultation in his case? (one or more correct answers)","item":"annales-2022-dp-17","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"His age, on its own, is sufficient to indicate an oncogenetic consultation.","justification":""},{"idx":1,"correct":false,"proposition":"The pathological characteristics of her breast cancer, alone, are sufficient to indicate an oncogenetic consultation.","justification":""},{"idx":2,"correct":true,"proposition":"his family history of breast cancer, on its own, is sufficient to indicate an oncogenetic consultation.","justification":""},{"idx":3,"correct":true,"proposition":"  in his case, a BRCA mutation may be present","justification":""},{"idx":4,"correct":true,"proposition":"in his case, a mutation predisposing to familial colon cancer syndrome (Lynch syndrome) may be present","justification":""}],"type":"dp"}
{"_id":"annales-2022-dp-17-qi-13","context":"You receive in consultation a woman of 52 years, second gesture, nulliparous, not taking contraception. Its body mass index is 42 kg\/m2. She has high blood pressure well controlled by perindopril, amlodipine and indapamide. She also has hypothyroidism of undetermined etiology requiring long-term thyroid hormone intake and also well-balanced type 2 diabetes under diet alone. She had surgery for a total left hip replacement 4 years ago. She has a family history of colon cancer in her father, from whom he died at the age of 59. She also reported breast cancer in her mother at the age of 47 and her maternal aunt at the age of 60.","enonce":" The patient had an oncogenetic consultation and a predisposition to familial colon cancer syndrome (Lynch syndrome) was diagnosed. What are the exact claims about this syndrome (one or more exact answers)?","item":"annales-2022-dp-17","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"It is characterized by a constitutional mutation of one of the MMR genes (Mis-Match-Repair)","justification":""},{"idx":1,"correct":false,"proposition":"It is inherited autosomal recessive","justification":""},{"idx":2,"correct":true,"proposition":"A prophylactic hysterectomy should be offered","justification":""},{"idx":3,"correct":true,"proposition":"A prophylactic bilateral appendectomy should be offered","justification":""},{"idx":4,"correct":false,"proposition":"A bilateral prophylactic mastectomy should be offered","justification":""}],"type":"dp"}
{"_id":"annales-2016-qi-2","context":null,"enonce":"A patient who is 35 weeks pregnant and 3 days pregnant is admitted to the maternity emergency room for pre-eclampsia: headache, blood pressure at 150\/90 mmHg, sharp osteotendinous reflexes, normal biological assessment except proteinuria at one gram per 24 hours. What treatment(s) do you implement?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Antenatal corticosteroid therapy"},{"idx":1,"correct":true,"proposition":"Magnesium sulphate"},{"idx":2,"correct":false,"proposition":"Tocolysis by atosiban IV"},{"idx":3,"correct":false,"proposition":"Antiplatelet agents"},{"idx":4,"correct":false,"proposition":"Antihypertensive treatment with calcium channel blockers"}],"type":"qi"}
{"_id":"annales-2016-qi-22","context":null,"enonce":"Which of the following should be included in the clinical examination of a patient with acute low back pain?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Search for a spinal deviation"},{"idx":1,"correct":true,"proposition":"Measurement of the Schoeber-McRae index"},{"idx":2,"correct":false,"proposition":"Score de BASDAI"},{"idx":3,"correct":false,"proposition":"ASIA score calculation"},{"idx":4,"correct":true,"proposition":"Search for a neurological deficit"}],"type":"qi"}
{"_id":"annales-2016-qi-27","context":null,"enonce":"Which of the following statements is (are) accurate? Chronic kidney disease is associated with an increased risk of:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Left ventricular hypertrophy"},{"idx":1,"correct":false,"proposition":"Deep vein thrombosis"},{"idx":2,"correct":false,"proposition":"Adrenal insufficiency"},{"idx":3,"correct":false,"proposition":"Type 2 diabetes"},{"idx":4,"correct":true,"proposition":"Hyperlipidemia"}],"type":"qi"}
{"_id":"annales-2016-qi-38","context":null,"enonce":"A monoclonal gammopathy of undetermined significance:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Is more often an IgG"},{"idx":1,"correct":false,"proposition":"Is usually discovered during an anemia check-up"},{"idx":2,"correct":false,"proposition":"Is usually discovered during a hypercalcemia assessment"},{"idx":3,"correct":true,"proposition":"Must be monitored due to the risk of malignant transformation"},{"idx":4,"correct":false,"proposition":"Does not accompany proteinuria."}],"type":"qi"}
{"_id":"annales-2016-qi-41","context":null,"enonce":"A 78-year-old patient complains of right hip pain after a fall. Here is the x-ray performed, you identify:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"A Garden 1 fracture"},{"idx":1,"correct":false,"proposition":"A Garden 2 fracture"},{"idx":2,"correct":true,"proposition":"A Garden 4 fracture"},{"idx":3,"correct":false,"proposition":"A fracture of the acetabulum"},{"idx":4,"correct":false,"proposition":"A fracture of the shutter frame"}],"type":"qi"}
{"_id":"annales-2016-qi-42","context":null,"enonce":"An isolated prolongation of the TCA is observed in the following situation(s):","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Factor VIII deficiency"},{"idx":1,"correct":true,"proposition":"Circulating anticoagulant"},{"idx":2,"correct":false,"proposition":"Preventive treatment with low molecular weight heparin"},{"idx":3,"correct":false,"proposition":"Disseminated intravascular coagulation"},{"idx":4,"correct":true,"proposition":"Willebrand disease"}],"type":"qi"}
{"_id":"annales-2016-qi-62","context":null,"enonce":"Risk factors for bladder tumours are:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Exposure to coal tar"},{"idx":1,"correct":true,"proposition":"Urinary schistosomiasis"},{"idx":2,"correct":false,"proposition":"Exposure to asbestos"},{"idx":3,"correct":true,"proposition":"Tobacco"},{"idx":4,"correct":false,"proposition":"A diet rich in polyunsaturated fatty acids"}],"type":"qi"}
{"_id":"annales-2016-qi-83","context":null,"enonce":"Which of the following proposals evokes the secondary character of a Raynaud's phenomenon?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"Start after 40 years"},{"idx":1,"correct":false,"proposition":"Respect for thumbs"},{"idx":2,"correct":true,"proposition":"Lack of summer remission"},{"idx":3,"correct":false,"proposition":"Female"},{"idx":4,"correct":false,"proposition":"Negativity of Allen's maneuver"}],"type":"qi"}
{"_id":"annales-2016-qi-91","context":null,"enonce":"Regarding open-angle glaucoma, what is (are) the exact proposal(s)?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":true,"proposition":"CAPM is a chronic progressive neuropathy"},{"idx":1,"correct":true,"proposition":"The incidence of CAPM increases with age"},{"idx":2,"correct":false,"proposition":"Normal intraocular pressure is defined as less than 25 mmHg"},{"idx":3,"correct":false,"proposition":"The decrease in visual acuity is early at the first signs of visual field damage"},{"idx":4,"correct":false,"proposition":"Treatment of CAPM is first-line surgical"}],"type":"qi"}
{"_id":"annales-2016-qi-94","context":null,"enonce":"Hydroxychloroquine is (one or more exact answers):","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Treatment of joint flare-ups of systemic lupus erythematosus"},{"idx":1,"correct":true,"proposition":"A background treatment for systemic lupus erythematosus"},{"idx":2,"correct":false,"proposition":"Contraindicated during pregnancy"},{"idx":3,"correct":true,"proposition":"Contraindicated in retinopathy"},{"idx":4,"correct":true,"proposition":"Indicated in low-intensity early rheumatoid arthritis"}],"type":"qi"}
{"_id":"annales-2016-qi-108","context":null,"enonce":"You perform blood gases in ambient air to a 68-year-old man who presents to the emergency room for increased dyspnea. The results are as follows: PaO2 58 mmHg; PaCO2 64 mmHg; pH 7.35; HCO3- 35.3 mmol\/L. What is (are) the mechanism(s) of hypoxemia?","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Intracardiac shunt"},{"idx":1,"correct":false,"proposition":"Alveolo-capillary diffusion disorder"},{"idx":2,"correct":true,"proposition":"Alveolar hypoventilation"},{"idx":3,"correct":false,"proposition":"Shunt effect"},{"idx":4,"correct":false,"proposition":"Intrahepatic shunt"}],"type":"qi"}
{"_id":"annales-2016-qi-119","context":null,"enonce":"Direct anti-Xa anticoagulants:","item":"annales-2016-qi","matiere":"annales-2016","propositions":[{"idx":0,"correct":false,"proposition":"Have a significant anticoagulant effect from about 12 h after taking"},{"idx":1,"correct":false,"proposition":"Do not accumulate in renal failure"},{"idx":2,"correct":false,"proposition":"Are indicated in wearers of mechanical prosthetic valves in AF"},{"idx":3,"correct":true,"proposition":"Have fewer drug interactions than VKAs"},{"idx":4,"correct":false,"proposition":"Require regular dosing of anti Xa activity"}],"type":"qi"}
{"_id":"annales-2017-qi-6","context":null,"enonce":"What is (are) the possible cause(s) of metrorrhagia in the 3rd trimester of pregnancy?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Retroplacental hematoma"},{"idx":1,"correct":true,"proposition":"Placenta prævia"},{"idx":2,"correct":true,"proposition":"Marginal abruption of a normally inserted placenta","justification":""},{"idx":3,"correct":false,"proposition":"Start of work"},{"idx":4,"correct":true,"proposition":"Benckiser's hemorrhage"}],"type":"qi"}
{"_id":"annales-2017-qi-43","context":null,"enonce":"A 45-year-old man consults in front of the appearance of erythematous lesions infiltrate of the right cheek appeared for a few weeks. The general state is preserved. What diagnoses can you evoke in front of this table?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"cutaneous sarcoidosis","justification":""},{"idx":1,"correct":false,"proposition":"Lupus tumidus","justification":""},{"idx":2,"correct":false,"proposition":"basal cell carcinoma","justification":""},{"idx":3,"correct":true,"proposition":"cutaneous lymphoma","justification":""},{"idx":4,"correct":true,"proposition":"Rosacea","justification":""}],"type":"qi"}
{"_id":"annales-2017-qi-48","context":null,"enonce":"In a patient in suicidal crisis, what symptom(s) is(are) in favor of a characterized depressive episode?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Loss of vital momentum"},{"idx":1,"correct":true,"proposition":"Crying"},{"idx":2,"correct":true,"proposition":"Psychomotor slowdown"},{"idx":3,"correct":true,"proposition":"Bulimia"},{"idx":4,"correct":false,"proposition":"Nightmares"}],"type":"qi"}
{"_id":"annales-2017-qi-58","context":null,"enonce":"Hypereosinophilia at 1800 \/ mm3 evolving for 1 month may be due to:","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Hodgkin's disease"},{"idx":1,"correct":false,"proposition":"Tissue amoebiasis"},{"idx":2,"correct":false,"proposition":"Atopy"},{"idx":3,"correct":true,"proposition":"Toxocariasis"},{"idx":4,"correct":true,"proposition":"Eosinophilic granulomatosis with polyangiitis","justification":""}],"type":"qi"}
{"_id":"annales-2017-qi-64","context":null,"enonce":"Which of the following biological explorations explores exocrine pancreatic function?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":true,"proposition":"Fecal fat flow","justification":""},{"idx":1,"correct":true,"proposition":"Determination of faecal elastase","justification":""},{"idx":2,"correct":false,"proposition":"Blood glucose testing","justification":""},{"idx":3,"correct":false,"proposition":"Lipasemia determination","justification":""},{"idx":4,"correct":false,"proposition":"Serum glucagon determination","justification":""}],"type":"qi"}
{"_id":"annales-2017-qi-113","context":null,"enonce":"A 22-year-old woman consults for this facial dermatosis evolving for several years with recent worsening since the modification of her oral contraception. What diagnosis do you mention?","item":"annales-2017-qi","matiere":"annales-2017","propositions":[{"idx":0,"correct":false,"proposition":"Rosacea","justification":""},{"idx":1,"correct":false,"proposition":"Lupus tumidus","justification":""},{"idx":2,"correct":false,"proposition":"Sarcoidosis","justification":""},{"idx":3,"correct":false,"proposition":"Acne","justification":""},{"idx":4,"correct":false,"proposition":"Seborrheic dermatitis","justification":""}],"type":"qi"}
{"_id":"annales-2018-qi-15","context":null,"enonce":"Which of the following infectious agents is responsible for blood culture negative endocarditis:","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Mycobacterium tuberculosis"},{"idx":1,"correct":true,"proposition":"Bartonella"},{"idx":2,"correct":false,"proposition":"Streptococcus pyogenes"},{"idx":3,"correct":true,"proposition":"Coxiella burnetii"},{"idx":4,"correct":true,"proposition":"Tropheryma whieplei"}],"type":"qi"}
{"_id":"annales-2018-qi-17","context":null,"enonce":"In a patient treated for 2 days for proximal pulmonary embolism with unfractionated heparin (UFH), the TCA ratio is 6 and anti-Xa activity is measured at peak activity at 1.2 Ul\/mL, in the absence of bleeding, which measure(s) do you take immediately? (one or more possible answers)","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Vitamin K intake"},{"idx":1,"correct":false,"proposition":"Platelet concentrate pellet infusion","justification":"The patient is asymptomatic"},{"idx":2,"correct":false,"proposition":"Protamine infusion"},{"idx":3,"correct":true,"proposition":"Discontinuation and dose adjustment","justification":"A TCA ratio of 6 is very (too) high! We do not want to exceed 3 as a general rule."},{"idx":4,"correct":false,"proposition":"Introduction of VKAs"}],"type":"qi"}
{"_id":"annales-2018-qi-34","context":null,"enonce":"Regarding osteoarthritis of the knee, what is (are) the true answer(s)?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Joint puncture is essential for diagnosis","justification":"Diagnosis is clinical and radiographic"},{"idx":1,"correct":false,"proposition":"Infiltrations by visco-supplementation are indicated in flare-ups with effusion","justification":""},{"idx":2,"correct":false,"proposition":"Surgical indication depends on the extent of joint pinching","justification":"It depends on the symptomatology (Lequesne index), which has no connection with radiology"},{"idx":3,"correct":true,"proposition":"A genu varum predisposes to medial femoro-tibial gonarthrosis","justification":""},{"idx":4,"correct":true,"proposition":"The effectiveness of corticosteroid infiltrations is limited in time","justification":""}],"type":"qi"}
{"_id":"annales-2018-qi-37","context":null,"enonce":"A 78-year-old former mechanic comes to consult for significant febrile inflammatory low back pain that has appeared for 10 days. You suspect spondylodiscite and decide to prescribe a lumbar MRI. This patient has a total hip replacement placed 8 years ago and a valve prosthesis for 2 years. He benefited from the placement of a coronary stent 3 months ago. It has a glomerular filtration rate of 48 ml\/min. During the interrogation, he tells you that he received shrapnel in his right eye and right cheek 40 years ago. Which proposal(s) contraindicate(s) the injected MRI?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Metallic splinters in the eye","justification":""},{"idx":1,"correct":false,"proposition":"Hip replacement","justification":"They do not contraindicate MRI"},{"idx":2,"correct":false,"proposition":"Prosthetic valve","justification":""},{"idx":3,"correct":false,"proposition":"The coronary stent","justification":""},{"idx":4,"correct":false,"proposition":"Kidney function","justification":""}],"type":"qi"}
{"_id":"annales-2018-qi-43","context":null,"enonce":"Which of the following foods contains more than 5% carbohydrates?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Lenses","justification":"20% carbohydrates, for your general culture;)"},{"idx":1,"correct":false,"proposition":"Green beans","justification":""},{"idx":2,"correct":false,"proposition":"Meat","justification":""},{"idx":3,"correct":false,"proposition":"Cheese 🧀","justification":""},{"idx":4,"correct":true,"proposition":"Fruit","justification":""}],"type":"qi"}
{"_id":"annales-2018-qi-54","context":null,"enonce":"A 32-year-old patient visits the emergency room for asthenia. There are no other abnormalities on clinical examination. An increase in transaminases was observed on biological examinations with AST = 1,362 IU (N<40), ALT = 2,348 IU (N<40). What is (are) the possible cause(s)?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Acute viral hepatitis","justification":""},{"idx":1,"correct":false,"proposition":"Acute alcoholic hepatitis","justification":"OGT\/AST are lower than TGP\/ALT"},{"idx":2,"correct":true,"proposition":"Drug hepatitis","justification":""},{"idx":3,"correct":true,"proposition":"Autoimmune hepatitis","justification":""},{"idx":4,"correct":false,"proposition":"Hepatitis related to cannabis use","justification":"Cannabis does not make hepatitis"}],"type":"qi"}
{"_id":"annales-2018-qi-70","context":null,"enonce":"What are the elements that guide you towards the occupational origin of allergic contact eczema in a plastics worker working in the manufacture of pleasure boats (one or more possible answers)?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The symptomatology that improves during the holidays","justification":""},{"idx":1,"correct":true,"proposition":"Localization of lesions on the backs of the hands and wrists","justification":"He works with his hands 😉"},{"idx":2,"correct":false,"proposition":"The presence of several simultaneous cases in the same workshop","justification":"Refers to irritation dermatitis"},{"idx":3,"correct":false,"proposition":"A history of atopy in childhood","justification":"Eczema (atopic dermatitis) should not be confused with contact dermatitis"},{"idx":4,"correct":true,"proposition":"The presence of lesions on the eyelids","justification":"He brings his hands to his eyes 👀"}],"type":"qi"}
{"_id":"annales-2018-qi-73","context":null,"enonce":"What hygiene measures should be taken when entering the room for the management of a patient with pulmonary tuberculosis?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Wearing a long-handled helmet","justification":""},{"idx":1,"correct":true,"proposition":"Wearing a respiratory protective mask (type FFP2)","justification":""},{"idx":2,"correct":false,"proposition":"Wearing a charlotte","justification":""},{"idx":3,"correct":false,"proposition":"Wearing overshoes","justification":""},{"idx":4,"correct":true,"proposition":"Hand rubbing with a hydroalcoholic solution","justification":""}],"type":"qi"}
{"_id":"annales-2018-qi-81","context":null,"enonce":"A patient presents with claudication for a distance estimated at 400 meters and which results in pain in the right calf. At the clinical examination you note: the absence of edema of the lower limbs, the presence of all peripheral pulses in the lower left limb. The popliteal pulse is however ample and very easy to palpate while on the right only the femoral pulse is perceived. There is no sensory or motor disorder in the lower limbs. You finally find a left iliac murmur. Which arterial injury(s) should you suspect?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Left iliac obliteration","justification":""},{"idx":1,"correct":true,"proposition":"Left iliac stenosis","justification":""},{"idx":2,"correct":true,"proposition":"Left popliteal aneurysm","justification":""},{"idx":3,"correct":false,"proposition":"Right iliac obliteration","justification":""},{"idx":4,"correct":false,"proposition":"Right femoral obliteration","justification":""}],"type":"qi"}
{"_id":"annales-2018-qi-87","context":null,"enonce":"Measures of association that can be estimated in a cross-sectional etiological epidemiological study include ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"The incidence rate","justification":"We are cross-sectional: we can only measure prevalence (but the two are not measures of associations)."},{"idx":1,"correct":true,"proposition":"The odds ratio","justification":"And not the relative 👀 risk. These are the only two measures of association."},{"idx":2,"correct":false,"proposition":"The mortality rate","justification":""},{"idx":3,"correct":false,"proposition":"Prevalence","justification":"It is not an association measure"},{"idx":4,"correct":false,"proposition":"The etiological fraction","justification":""}],"type":"qi"}
{"_id":"annales-2018-qi-89","context":null,"enonce":"Which of the following parasitosis is transmitted through skin contact (barefoot walking, swimming) with water or moist soil?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Amoebose","justification":"Oral"},{"idx":1,"correct":false,"proposition":"Teniosis","justification":"Oral"},{"idx":2,"correct":false,"proposition":"Hydatidosis (echinococcosis)","justification":"Oral"},{"idx":3,"correct":true,"proposition":"Strongyloidiasis (anguillulosis)","justification":"Barefoot walking on the sand"},{"idx":4,"correct":true,"proposition":"Schistosomoses (bilharzia)","justification":"Freshwater swimming"}],"type":"qi"}
{"_id":"annales-2018-qi-90","context":null,"enonce":"The medical certificate describing injuries secondary to violence: (one or more exact answers) ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Must mention the psychological impact of the violence on the victim","justification":""},{"idx":1,"correct":false,"proposition":"May be handed over directly to a judicial police officer if the total incapacity for work exceeds eight days","justification":"Always to the patient directly, unless minor (given to an adult) or requisition (given to the OPJ)"},{"idx":2,"correct":false,"proposition":"May be handed over directly to a third party provided that he provides proof of his link with the victim","justification":""},{"idx":3,"correct":true,"proposition":"Is handed over to the holder of parental authority if the victim is a minor","justification":""},{"idx":4,"correct":false,"proposition":"Allows to see on the medical level the credibility of the victim's remarks","justification":""}],"type":"qi"}
{"_id":"annales-2018-qi-96","context":null,"enonce":"You receive a consultation with a pregnant woman for the morphological ultrasound of 22 weeks of amenorrhea. Her couple has no family history. Fetal growth is normal. She received combined screening in the first trimester with a risk of trisomy 21 calculated at 1\/10,000. The only peculiarity is fetal intestinal hyperechogenicity. What is the exact proposal(s)?","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"This is a call sign of cystic fibrosis","justification":""},{"idx":1,"correct":true,"proposition":"This is a call sign of a viral infection","justification":""},{"idx":2,"correct":false,"proposition":"This sign is frequently encountered in heterozygous fetuses for a severe mutation of the CFTR gene.","justification":"homozygous"},{"idx":3,"correct":true,"proposition":"Priority is given to heterozygosity testing for 2 parents","justification":""},{"idx":4,"correct":false,"proposition":"Priority is given to amniocentesis for testing for mutations in the CFTR gene in the fetus","justification":""}],"type":"qi"}
{"_id":"annales-2018-qi-100","context":null,"enonce":"Cite the potential consequence(s) of a drug combination with a cytochrome P450 3A4 inducer drug:","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Ciclosporin transplant rejection ","justification":""},{"idx":1,"correct":false,"proposition":"Ergotism in the presence of ergotamine","justification":""},{"idx":2,"correct":false,"proposition":"Rhabdomyolysis in the presence of certain statins","justification":""},{"idx":3,"correct":true,"proposition":"Pregnancy on estrogen-progestin","justification":""},{"idx":4,"correct":true,"proposition":"Failure of antiretroviral therapy","justification":""}],"type":"qi"}
{"_id":"annales-2018-qi-115","context":null,"enonce":"Molecular biology analyses as part of the histopathological diagnosis of a tumor (one or more exact answers) ","item":"annales-2018-qi","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Can be taken from tissue samples fixed and included in paraffin","justification":""},{"idx":1,"correct":true,"proposition":"can be made on non-fixed tissue samples coogeled at - 80 ° C","justification":""},{"idx":2,"correct":true,"proposition":"can be done on cell smears in liquid medium","justification":""},{"idx":3,"correct":true,"proposition":"Require morphological control of tissue sampling","justification":""},{"idx":4,"correct":false,"proposition":"require a signed authorization from the patient","justification":""}],"type":"qi"}
{"_id":"annales-2020-qi-50","context":null,"enonce":"Adenocarcinomas are a common histological type of cancer: (one or more exact answers) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"From the lung","justification":""},{"idx":1,"correct":true,"proposition":"From the endometrium","justification":""},{"idx":2,"correct":false,"proposition":"From the cervix","justification":""},{"idx":3,"correct":true,"proposition":"From the ovary","justification":""},{"idx":4,"correct":false,"proposition":"From the testicle","justification":""}],"type":"qi"}
{"_id":"annales-2020-qi-52","context":null,"enonce":"Regarding generalized amyloidosis it is true that: (one or more possible answers) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Accessory salivary gland biopsy is a preferred biopsy site","justification":""},{"idx":1,"correct":false,"proposition":"Transparietal liver biopsy is a preferred biopsy site","justification":""},{"idx":2,"correct":true,"proposition":"The coloring by congo red is done on fixed fabric","justification":""},{"idx":3,"correct":true,"proposition":"AL amyloidosis is linked to lambda light chain deposits","justification":""},{"idx":4,"correct":true,"proposition":"AL amyloidosis may be related to monoclonal gammopathy of undetermined significance (MGUS)","justification":""}],"type":"qi"}
{"_id":"annales-2020-qi-53","context":null,"enonce":"You take care of Mrs. D., 28, who consults for febrile meningeal syndrome without signs of neurological focus. As part of your diagnostic strategy, you decide to perform a lumbar puncture. As an operator, which proposal(s) is(are) accurate?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"You must wear a surgical mask","justification":""},{"idx":1,"correct":true,"proposition":"Wearing gloves is a measure to prevent accidents involving exposure to blood or body fluids","justification":""},{"idx":2,"correct":true,"proposition":"You perform antisepsis in two steps","justification":""},{"idx":3,"correct":false,"proposition":"A disinfection of your hands must be carried out after the performance of the gesture","justification":"⚠ Recurrent trap: only inert surfaces are DISINFECTED. For living surfaces, ANTISEPTIC or STERILIZED. It is not the same term. The proposal is therefore false."},{"idx":4,"correct":false,"proposition":"The disposal of the needle in a container for a puncture, cutting or cutting object is a risk prevention measure a posteriori","justification":"Here is the memo sheet of the HAS concerning the lumbar puncture where we find the answers to this IQ: https:\/\/www.has-sante.fr\/upload\/docs\/application\/pdf\/2019-07\/fm_ponction_lombaire.pdf 👉 It is advisable to read it ++"}],"type":"qi"}
{"_id":"annales-2020-qi-58","context":null,"enonce":"Regarding septic arthritis on native joint (without prosthesis), which is (are) the true proposition(s) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"The germ most often involved is streptococcus","justification":""},{"idx":1,"correct":false,"proposition":"Joint lavage is systematic in therapeutic management","justification":""},{"idx":3,"correct":true,"proposition":"Antibiotic therapy often involves a combination of 2 antibiotics","justification":""},{"idx":2,"correct":true,"proposition":"Bacteriological diagnosis can be made on blood cultures","justification":""},{"idx":4,"correct":false,"proposition":"The duration of antibiotic therapy is 12 weeks","justification":"3 months is a little bit much 😯. Most often, the total duration is around a month and a half (4 to 6 weeks)."}],"type":"qi"}
{"_id":"annales-2020-qi-61","context":null,"enonce":"A 27-year-old patient has an abnormal blood count. The results of this report are as follows: \n\nHb 13 g\/dL;\n VGM 86;\n blisters 310 g\/L -\n leukocytes 12 g\/L -\n neutrophils 3.7 g\/L -\n eosinophilic polynuclear 6 g\/L -\n basophil polynuclear 0.08 g\/L -\n lymphocytes 1.6 G\/L\n monocytes 0.5 G\/L.\n\nThe patient has never travelled and has no significant history. She complains of pruritus that has been progressing for a few weeks, without associated skin lesions. There is no other functional sign at the interrogation. Which diagnostic hypothesis(s) should you mention in front of this clinico-biological picture? (one or more expected answers) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Atopy","justification":"Hypereosinophilia atopy 👉 less than 1.5G\/L."},{"idx":1,"correct":true,"proposition":"Toxocariasis","justification":"Common cause of autochthonous eosinophilia."},{"idx":2,"correct":true,"proposition":"Drug cause","justification":""},{"idx":3,"correct":true,"proposition":"Hodgkin's disease","justification":""},{"idx":4,"correct":false,"proposition":"Systemic lupus","justification":""}],"type":"qi"}
{"_id":"annales-2020-qi-63","context":null,"enonce":"You see a 38-year-old patient who would like to be able to quit smoking cIgArettes. His father has just died of bronchial cancer. The patient started smoking at the age of 14. He studied at a vocational high school. He currently smokes 2 packs a day. Its overall smoking is estimated at 40 pack-years. In the morning as soon as his alarm goes off he turns on a cIgArette. He sometimes smokes in the shower which is not easy. He drinks alcohol only occasionally. He would like nicotine substitutes that he has heard about. Which proposals are correct? (one or more correct answers)","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The patient has a strong pharmacological dependence on nicotine","justification":""},{"idx":1,"correct":false,"proposition":"The notion of 40 smoked pack-years (PA) indicates that weaning will be difficult","justification":"There is no demonstrated link between APs and difficulty weaning."},{"idx":2,"correct":false,"proposition":"The amount of tobacco smoked per day is the main risk factor for bronchial cancer","justification":""},{"idx":3,"correct":true,"proposition":"Alcohol consumption, even controlled, is a risk factor for relapse of smoking","justification":""},{"idx":4,"correct":true,"proposition":"The prescription of nicotine substitutes will require a dosage close to 40 mg \/ day","justification":""}],"type":"qi"}
{"_id":"annales-2020-qi-82","context":null,"enonce":"Regarding myasthenia gravis, which is (are) the exact proposal(s)?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"The engine deficit is constant","justification":""},{"idx":1,"correct":true,"proposition":"Involvement of the oculo-palpebral musculature is usually asymmetrical","justification":""},{"idx":2,"correct":true,"proposition":"The fatIgAbility of the cervical muscles is classic","justification":""},{"idx":3,"correct":true,"proposition":"Pupillary motility is normal","justification":""},{"idx":4,"correct":false,"proposition":"Motor involvement predominates on the distal muscles","justification":""}],"type":"qi"}
{"_id":"annales-2020-qi-86","context":null,"enonce":"A 67-year-old patient, type 2 diabetic, is followed in nephrology for diabetic nephropathy. Her ambulatory blood pressures are 151\/89 mmHg on average (diurnal). She has edema of the lower limbs. Its biological balance finds a serum creatinine 2), a serum potassium level of 5.1 mmol \/ L, an alkaline reserve of 170 μmol \/ L (DFG CKD EPI 25 ml \/ min \/ 1.73m to 19 mmol \/ L, proteinuria at 1 g \/ g creatinineuria. She is treated with metformin, ramipril and cholecalciferol. What therapeutic measures should be taken in this patient? (one or more correct answers) ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Discontinuation of metformin","justification":"GFR < 30"},{"idx":1,"correct":true,"proposition":"Starting treatment with furosemide","justification":"She has edema of the lower limbs."},{"idx":2,"correct":false,"proposition":"Starting treatment with amiloride","justification":"She is hyperkalemia."},{"idx":3,"correct":false,"proposition":"Start of hydrochlorothiazide therapy","justification":"GFR < 30."},{"idx":4,"correct":true,"proposition":"low-salt diet (less than 6 g\/d)","justification":"."}],"type":"qi"}
{"_id":"annales-2020-qi-88","context":null,"enonce":"You ask a 63-year-old patient, whose BMI is 29 kg\/m^2, to reduce his dietary intake of saturated fatty acids because he has just been diagnosed with type 2 diabetes.\nWhich of the following foods should be targeted for to reduce daily intake of saturated fatty acids?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Crescent 🥐"},{"idx":1,"correct":false,"proposition":"Salmon 🐟"},{"idx":2,"correct":true,"proposition":"Cheese 🧀"},{"idx":3,"correct":false,"proposition":"Olive oil 🛢"},{"idx":4,"correct":false,"proposition":"Peanut 🪔 oil"}],"type":"qi"}
{"_id":"annales-2020-qi-89","context":null,"enonce":"You are called as an expert in a potentially criminal story of hypoglycemia in a type 2 diabetic patient, who was found in a coma at his home and eventually died in hospital of a massive stroke. The SAMU doctor had taken a sample which could be technical later, the results of which are as follows: • blood glucose: 2.2 mmol \/ L - • insulinemia: 50 μU \/ ml (normal values on an empty stomach: 5 to 15 μU \/ ml); • C-peptide: 3 nmol\/L (normal fasting values: 0.4 to 1.2 nmol\/L). \n\nHis wife is suspected of having caused this coma. Given the elements at your disposal, which of these therapeutic classes could have been used to obtain this biological and clinical assessment? ","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Sitagliptin overdose","justification":""},{"idx":1,"correct":false,"proposition":"Overdose of ordinary insulin","justification":"The C-peptide would be indosable."},{"idx":2,"correct":false,"proposition":"Metformin overdose","justification":""},{"idx":3,"correct":false,"proposition":"Liraglutide overdose","justification":""},{"idx":4,"correct":true,"proposition":"Gliclazide overdose","justification":"Glucazides (sulfonamides) are hypoglycemic insulin-secretors. They cause an endogenous release of insulin, which corresponds well to this situation."}],"type":"qi"}
{"_id":"annales-2020-qi-92","context":null,"enonce":"A 32-year-old patient, with no history, a dynamic executive leaving for a business trip to the United States in 48 hours, complains of heartburn. He is seeing a gastroenterologist today. The clinical examination is unremarkable. Upper gastrointestinal endoscopy is indicated. The patient wants it to be performed under general anesthesia. What is the true proposal(s) if the anaesthetist is immediately available to see the patient?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Endoscopy can be performed today","justification":""},{"idx":1,"correct":false,"proposition":"Endoscopy can be performed tomorrow","justification":""},{"idx":2,"correct":false,"proposition":"Endoscopy can be performed the day after tomorrow early in the morning before travel","justification":""},{"idx":3,"correct":true,"proposition":"Endoscopy can be performed the day after tomorrow if the trip is cancelled","justification":""},{"idx":4,"correct":true,"proposition":"Endoscopy can be performed within 72 hours","justification":""}],"type":"qi"}
{"_id":"annales-2020-qi-105","context":null,"enonce":"Which teeth can cause chronic right purulent maxillary sinusitis? (one or more expected answers)","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Tooth n°28","justification":"She is on the left 😉"},{"idx":1,"correct":true,"proposition":"Tooth n°15"},{"idx":2,"correct":true,"proposition":"right upper first premolar"},{"idx":3,"correct":false,"proposition":"right upper central incisor","justification":"It is a bit far from the maxillary sinus! Only the molars and premolars are close enough to be able to give maxillary sinusitis."},{"idx":4,"correct":true,"proposition":"right upper first molar","justification":""}],"type":"qi"}
{"_id":"annales-2020-qi-113","context":null,"enonce":"Regarding osteoporotic fractures, which proposal(s) is (are) right?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The decrease in the height of the individual may be the only witness of osteoporotic vertebral fractures","justification":""},{"idx":1,"correct":true,"proposition":"The majority of them are severe","justification":""},{"idx":2,"correct":false,"proposition":"They require high-energy trauma","justification":""},{"idx":3,"correct":false,"proposition":"Vertebral fractures are often very symptomatic","justification":""},{"idx":4,"correct":true,"proposition":"Femoral neck fractures are associated with significant excess mortality","justification":""}],"type":"qi"}
{"_id":"annales-2020-qi-119","context":null,"enonce":"Regarding hemorrhoidal pathology, which proposal(s) is(are) true?","item":"annales-2020-qi","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Hemorrhoidal prolapse corresponds to the externalization of internal hemorrhoidal packages through the anus","justification":""},{"idx":1,"correct":false,"proposition":"Symptomatic hemorrhoids are a risk factor for degeneration into squamous cell cancer","justification":"Whether they are symptomatic or not does not come into play."},{"idx":2,"correct":true,"proposition":"Acute hemorrhoidal thrombosis can be incised urgently to evacuate a clot","justification":""},{"idx":3,"correct":false,"proposition":"In case of hemorrhoids responsible for rectal bleeding evident on clinical examination in a 65-year-old man, colonoscopy is not essential","justification":""},{"idx":4,"correct":false,"proposition":"It is necessary to operate all symptomatic hemorrhoids","justification":""}],"type":"qi"}
{"_id":"annales-2022-qi-1","context":null,"enonce":" This 5-year-old child is taken by his parents to the pediatric emergency room for a rash that appeared for 2 days and has since spread. The lesions are present all over the body, they are itchy. There is hyperthermia at 38°5C.  The examination of the health record is without particularity and the mandatory vaccinations are up to date. What is your diagnosis?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Scabies","justification":""},{"idx":1,"correct":false,"proposition":"Chickenpox","justification":""},{"idx":2,"correct":false,"proposition":"Syndrome de Kaposi-Juliusberg","justification":""},{"idx":3,"correct":false,"proposition":"Primary herpes infection","justification":""},{"idx":4,"correct":false,"proposition":"Erythema multiforme","justification":""}],"type":"qi"}
{"_id":"annales-2022-qi-23","context":null,"enonce":" A young patient of 28 years comes to see you for consultation. He is of Malian origin, arrived in France 2 years ago. He consults for pain at the time of urination radiating to the anus evolving for 6 months. It also exhibits diurnal and nocturnal pollakiuria at more than 20 urinations per day. He occasionally describes right lower back pain. The clinical examination does not find any abnormality on inspection or palpation. The digital rectal exam is normal. He is 1m94 tall and weighs 79 kg. Heart rate is 62\/min and BP is 110\/78 mmHg. Cytobacteriological examination of urine reveals: white blood cells 10\/mm 3, red blood cells 25,000\/mm 3, no bacteria on direct examination or culture. What is your main diagnostic hypothesis?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Alport syndrome","justification":""},{"idx":1,"correct":false,"proposition":"Subacute prostatitis","justification":""},{"idx":2,"correct":false,"proposition":"Urinary schistosomiasis","justification":""},{"idx":3,"correct":false,"proposition":"Berger's disease","justification":""},{"idx":4,"correct":false,"proposition":"ANCA vasculitis","justification":""}],"type":"qi"}
{"_id":"annales-2022-qi-25","context":null,"enonce":" You are reviewing the publication of a double-blind, multicenter randomized clinical trial. The objective of this trial was to evaluate the efficacy and safety of a novel monoclonal antibody, directed against a pro-inflammatory cytokine produced by neutrophils, in subjects hospitalized with SARS-CoV-2 infection, oxygen-dependent but not in the context of resuscitation. Which of the outcomes assessed is which one do you think is clinically relevant?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Evolution of the viral load measured on nasopharyngeal swabs between the 1st day and the 10th day of hospitalization","justification":""},{"idx":1,"correct":false,"proposition":"30-day all-cause mortality","justification":""},{"idx":2,"correct":false,"proposition":"Evolution of the blood neutrophil level between the 1st day and the 10th day of hospitalization","justification":""},{"idx":3,"correct":false,"proposition":"Length of hospital stay","justification":""},{"idx":4,"correct":false,"proposition":"Transfer to intensive care for acute respiratory distress syndrome at 30 days","justification":""}],"type":"qi"}
{"_id":"annales-2022-qi-27","context":null,"enonce":" A doctor tells a patient about metastatic cancer. Throughout the constutiation, he held a very technical speech, rich in medical terms preventing a real dialogue with the patient. What \"psycho-adaptive\" mechanism does this doctor's behavior correspond to? (only one answer expected)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Denial","justification":""},{"idx":1,"correct":false,"proposition":"Aggressive projection","justification":""},{"idx":2,"correct":false,"proposition":"Rationalization","justification":""},{"idx":3,"correct":false,"proposition":"Avoidance","justification":""},{"idx":4,"correct":false,"proposition":"Commoditization","justification":""}],"type":"qi"}
{"_id":"annales-2022-qi-32","context":null,"enonce":" You come back to see at his home Mr G, 83 years old, for whom you had already been asked for a rebellious cough. Mr G lives with his 56-year-old daughter, a switchboard operator, and his 26-year-old grandson, a mechanic. Mr G and his daughter have not received a vaccine for at least 20 years. Her grandson is completely up to date with his vaccination schedule. Mr G plays belote at the senior club on Thursday afternoons with a 79-year-old friend with respiratory insufficiency who has always refused vaccinations. You had thought of the possibility of whooping cough, which has just been confirmed while it has now been 2 weeks that he coughs. You decide to treat Mr G with 3 days of azithromycin. In addition to this treatment, what proposal(s) do you retain?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Prescription of 3 days of azithromycin to her daughter","justification":""},{"idx":1,"correct":false,"proposition":"Prescription of 3 days of azithromycin to his grandson","justification":""},{"idx":2,"correct":false,"proposition":"Prescription of 3 days of azithromycin to his belote partner","justification":""},{"idx":3,"correct":false,"proposition":"No outing during the next 3 weeks","justification":""},{"idx":4,"correct":false,"proposition":"Notification of the case to the RHA","justification":""}],"type":"qi"}
{"_id":"annales-2022-qi-46","context":null,"enonce":" You receive a 35-year-old patient with facial pain and left purulent rhinorrhea. What associated signs or symptoms would be in favor of frontal sinusitis? (one or more expected answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"supraorbital localization of pain","justification":""},{"idx":1,"correct":false,"proposition":"filling of the inner angle of the eye (eyelid edema)","justification":""},{"idx":2,"correct":false,"proposition":"occipital irradiation of pain","justification":""},{"idx":3,"correct":false,"proposition":"homolateral nasal obstruction","justification":""},{"idx":4,"correct":false,"proposition":"pulsatile nature of pain","justification":""}],"type":"qi"}
{"_id":"annales-2022-qi-51","context":null,"enonce":" A 16-year-old girl expresses suicidal thoughts. Which of the proposals concerning these suicidal ideation expressed is(s) the exact proposal(s)?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"they are commonplace in adolescence","justification":""},{"idx":1,"correct":false,"proposition":"they are an indication for antidepressant treatment","justification":""},{"idx":2,"correct":false,"proposition":"they often indicate a personality disorder","justification":""},{"idx":3,"correct":false,"proposition":"they specifically affect adolescents in precarious social situations","justification":""},{"idx":4,"correct":false,"proposition":"they constitute a psychiatric emergency","justification":""}],"type":"qi"}
{"_id":"annales-2022-qi-72","context":null,"enonce":" Mrs. O, aged 32, is hospitalized in intensive care at the request of her obstetrician whom she has just consulted for marked edema of the lower limbs of progressive installation over a week. She complains of shortness of breath when she goes to bed at night for 72 hours. It is primiparous, at 32 weeks of amenorrhea. His vital parameters when he arrived in the department are as follows: blood pressure at 170\/130 mmHg, heart rate at 110\/min, respiratory rate at 20\/min for ambient air saturation at 92%. The urine strip performed in obstetrics consultation showed proteinuria +++. She complains of frontal bar headache and blurred vision. The osteotendinous reflexes are lively and polykinetic to the 4 limbs. You do not yet have the results of the biological work-up taken in obstetrics. The fetal heart rhythm is normal. Regarding the management of this patient, which proposal(s) is (are) accurate?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Bladder catheterization is essential","justification":""},{"idx":1,"correct":false,"proposition":"you tolerate current blood pressure","justification":""},{"idx":2,"correct":false,"proposition":"you prescribe a calcium channel blocker","justification":""},{"idx":3,"correct":false,"proposition":"you prescribe magnesium sulfate","justification":""},{"idx":4,"correct":false,"proposition":"you prescribe an ACE inhibitor","justification":""}],"type":"qi"}
{"_id":"annales-2022-qi-75","context":null,"enonce":" Which symptom(s) can (can) lead to a diagnosis of amyotrophic lateral sclerosis?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"dysarthria","justification":""},{"idx":1,"correct":false,"proposition":"urinary problems","justification":""},{"idx":2,"correct":false,"proposition":"pyramidal syndrome","justification":""},{"idx":3,"correct":false,"proposition":"amyotrophy","justification":""},{"idx":4,"correct":false,"proposition":"hypopallesthesia","justification":""}],"type":"qi"}
{"_id":"annales-2022-qi-83","context":null,"enonce":" You receive a 17-year-old girl who has no particular history in consultation for information on contraception. During your clinical examination, you note the following: height 156 cm, weight 52 kg (BMI 21.4 kg\/m2). Its pubic hair is not very abundant and its breast bud is not developed. There is no axillary hair, no acne or hyperseborrhea. She tells you she never had her period, but hasn't worried about it so far because her mom got her period late. Which diagnostic hypothesis(s) do you think are compatible with this table?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"pituitary prolactin adenoma","justification":""},{"idx":1,"correct":false,"proposition":"simple pubertal delay","justification":""},{"idx":2,"correct":false,"proposition":"Turner syndrome","justification":""},{"idx":3,"correct":false,"proposition":"anorexia nervosa","justification":""},{"idx":4,"correct":false,"proposition":"21-hydroxylase block","justification":""}],"type":"qi"}
{"_id":"annales-2022-qi-102","context":null,"enonce":" The management of a steady-state COPD patient with FEV1 at 65% of the predicted value and daily exercise dyspnea and no history of COPD exacerbation is based primarily on: (one or more exact answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Quitting smoking","justification":""},{"idx":1,"correct":false,"proposition":"Rehabilitation to exercise","justification":""},{"idx":2,"correct":false,"proposition":"Systemic corticosteroid therapy","justification":""},{"idx":3,"correct":false,"proposition":"A long-acting bronchodilator","justification":""},{"idx":4,"correct":false,"proposition":"Inhaled corticosteroid monotherapy","justification":""}],"type":"qi"}
{"_id":"annales-2022-qi-109","context":null,"enonce":" You are taking care of a 27-year-old patient, a community cook, who has suffered a severe trauma responsible for a serious head trauma, a multifragmentary fracture of the right femoral diaphysis osteosynthesized by a centromedullary nail. He has complete stiffness in his right knee. He has right hemiparesis without hypertonia but can mobilize his hemibody without much difficulty. The rating according to the MRC scale (medical research council) is generally between 3 and 4 on the right hemibody. On the other hand, he has cognitive impairment and remains very confused. It is still mainly fed by nasogastric tube. Initial feeding tests were attempted by the nurse. Which proposal(s) is (are) the exact proposal(s)?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"After the care phase in neurosurgery and orthopedics, you feel that the optimal orientation is in neurological follow-up care.","justification":""},{"idx":1,"correct":false,"proposition":"The recovery of knee flexion is essential for its walking autonomy especially for stairs","justification":""},{"idx":2,"correct":false,"proposition":"If he has to work again, the recognition \"disabled worker\" is to be requested from the vocational training center for adults","justification":""},{"idx":3,"correct":false,"proposition":"The swallowing assessment requires the expertise of a speech-language pathologist","justification":""},{"idx":4,"correct":false,"proposition":"Muscle strengthening of the thigh is essential to recover knee mobility","justification":""}],"type":"qi"}
{"_id":"annales-2022-qi-110","context":null,"enonce":" A 42-year-old woman consults for meno-metrorrhagia evolving for several years. Adenomyosis was diagnosed. Various treatments have been tried without success (oral progestogens, levonorgestrel-releasing intrauterine device, hysteroscopic endometrectomy). Laparoscopic hysterectomy is considered. What information(s) do you give him about this intervention?","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"it leads to menopause","justification":""},{"idx":1,"correct":false,"proposition":"it causes infertility","justification":""},{"idx":2,"correct":false,"proposition":"the cervix can be preserved","justification":""},{"idx":3,"correct":false,"proposition":"bilateral oophorectomy should be combined","justification":""},{"idx":4,"correct":false,"proposition":"General anesthesia should be performed","justification":""}],"type":"qi"}
{"_id":"annales-2022-qi-119","context":null,"enonce":" About fragile X syndrome, what are the exact answers? (one or more correct answers)","item":"annales-2022-qi","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Fragile X syndrome is a cause of intellectual disability in boys","justification":""},{"idx":1,"correct":false,"proposition":"It only reaches boys","justification":""},{"idx":2,"correct":false,"proposition":"It is a disease related to an expansion of trinucleotides in the non-coding region of the FMR1 gene","justification":""},{"idx":3,"correct":false,"proposition":"The diagnosis of certainty of fragile X syndrome is made on a chromosomal analysis","justification":""},{"idx":4,"correct":false,"proposition":"Clinical expression results from overexpression of the FMR1 gene","justification":""}],"type":"qi"}
{"_id":"annales-2019-qi-1","context":null,"enonce":"A 70-year-old patient presents to the emergency room with chest pain and dyspnea. The imaging examination performed is:","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Magnetic resonance imaging after iodinated contrast medium injection","justification":""},{"idx":1,"correct":false,"proposition":"Magnetic resonance imaging without iodinated contrast medium injection","justification":""},{"idx":2,"correct":true,"proposition":"A CT scan after injection of iodinated contrast medium","justification":"CT, unlike MRI, allows you to see the bones much more strongly. The injection is recognized because there is a difference in density between the arteries and veins."},{"idx":3,"correct":false,"proposition":"A CT scan without injection of iodinated contrast medium","justification":""},{"idx":4,"correct":false,"proposition":"An infusion scan","justification":""}],"type":"qi"}
{"_id":"annales-2019-qi-9","context":null,"enonce":"A 71-year-old patient, hypertensive, hypothyroid receiving opo replacement therapy, consults you for significant pain of the right hemiface. You suspect neuralgia of the right trigeminal. What is (are) the proposal(s) evocative of the diagnosis?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Sensation of electric discharge","justification":""},{"idx":1,"correct":true,"proposition":"Trigger zone","justification":""},{"idx":2,"correct":false,"proposition":"Retroorbital pain","justification":""},{"idx":3,"correct":false,"proposition":"Posterior scalp pain","justification":""},{"idx":4,"correct":false,"proposition":"Rhinorrhea","justification":""}],"type":"qi"}
{"_id":"annales-2019-qi-12","context":null,"enonce":"Regarding this chest X-ray of a 6-month-old child performed due to a febrile cough, what is (are) the exact proposal(s)?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"There is a right thymic overhang","justification":""},{"idx":1,"correct":false,"proposition":"There is left upper lobar lung disease","justification":"It is the thymic lodge that gives this opacity"},{"idx":2,"correct":false,"proposition":"There is chest distension","justification":""},{"idx":3,"correct":true,"proposition":"The trachea is in place","justification":""},{"idx":4,"correct":true,"proposition":"The small split is in place","justification":""}],"type":"qi"}
{"_id":"annales-2019-qi-18","context":null,"enonce":"Mr. X., 66 years old, is a carrier of a subrenal abdominal aortic aneurysm measured 3 months ago at 40 mm anteroposterior diameter. He presents to the emergency room for the occurrence of acute abdominal pain. On clinical examination, the pulse is 88 bpm, blood pressure is 134\/68 mmHg in both arms. What action do you propose to take in this patient? (Only one exact proposal)","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Emergency abdominal CT scan","justification":""},{"idx":1,"correct":false,"proposition":"Emergency abdominal ultrasound","justification":""},{"idx":2,"correct":false,"proposition":"Arteriography of the aorta and lower limbs in emergency","justification":""},{"idx":3,"correct":false,"proposition":"Emergency exploratory laparotomy without prior imaging","justification":""},{"idx":4,"correct":false,"proposition":"X-ray of the abdomen without emergency preparation","justification":""}],"type":"qi"}
{"_id":"annales-2019-qi-50","context":null,"enonce":"Researchers are interested in the relationship between disease M and exposure E. To this end, they constitute a cohort representative of their population of interest. At the end of the 10 years of follow-up, 300 subjects became ill. The results are summarized in the contingency table below. About this study: (one or more correct answers)","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"The base risk is 20%","justification":""},{"idx":1,"correct":true,"proposition":"The excess risk is 10%","justification":""},{"idx":2,"correct":false,"proposition":"The relative risk is 2.25","justification":""},{"idx":3,"correct":false,"proposition":"The risk in exposed is increased by 100% compared to the risk of non-exposed","justification":""},{"idx":4,"correct":false,"proposition":"The cumulative incidence of the disease is equal to 0.15 in the sample","justification":""}],"type":"qi"}
{"_id":"annales-2019-qi-67","context":null,"enonce":"Which of the following clinical signs is a criterion(s) for hospitalization of a 15-year-old girl with anorexia nervosa?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"A restrictive diet of food","justification":""},{"idx":1,"correct":false,"proposition":"Amenorrhea"},{"idx":2,"correct":true,"proposition":"Tachycardia"},{"idx":3,"correct":false,"proposition":"Body mass index of 16 kg\/m2","justification":""},{"idx":4,"correct":true,"proposition":"Lipothymia"}],"type":"qi"}
{"_id":"annales-2019-qi-84","context":null,"enonce":"You see in consultation a 32-year-old man who has a complete sensorimotor paraplegia of level T6 following a bicycle accident dating back several years. He is concerned about a right ischial redness present for 3 weeks. Regarding this lesion:","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"This is a stage 1 pressure ulcer","justification":""},{"idx":1,"correct":false,"proposition":"Ischial localization is unusual","justification":""},{"idx":2,"correct":true,"proposition":"Removal of support is recommended","justification":""},{"idx":3,"correct":false,"proposition":"Massages are recommended","justification":""},{"idx":4,"correct":false,"proposition":"A preventive surgical procedure is recommended","justification":""}],"type":"qi"}
{"_id":"annales-2019-qi-88","context":null,"enonce":"In children, antibiotic prophylaxis in infective endocarditis is recommended in case of ?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Prosthetic valve","justification":""},{"idx":1,"correct":false,"proposition":"Inter-atrial communication","justification":""},{"idx":2,"correct":true,"proposition":"Non-operated cyanogenic heart disease","justification":""},{"idx":3,"correct":false,"proposition":"Coarctation of the aorta","justification":""},{"idx":4,"correct":true,"proposition":"History of infective endocarditis","justification":""}],"type":"qi"}
{"_id":"annales-2019-qi-90","context":null,"enonce":"X-ray of the front chest performed as part of an asthenia assessment in an 11-year-old child. What is the exact proposal(s)?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"There is cardiomegaly","justification":""},{"idx":1,"correct":false,"proposition":"The para-aortic line is repressed","justification":""},{"idx":2,"correct":false,"proposition":"There is pleural effusion","justification":""},{"idx":3,"correct":false,"proposition":"There is an anterior mediastinal mass","justification":""},{"idx":4,"correct":false,"proposition":"There is a systematized alveolar opacity","justification":""}],"type":"qi"}
{"_id":"annales-2019-qi-95","context":null,"enonce":"A 52-year-old patient consults you for diarrhea consisting of 6 to 8 watery stools per day, including two nocturnal ones, associated with urges. Since the onset of these symptoms 6 months earlier, the patient has lost 3 kg. There is no abdominal pain. The patient has pyrosis treated with lansoprazole, high blood pressure treated with amlopidine and diabetes treated for 2 years with glibenclamide. Which factor(s) may be responsible for this diarrhea?","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Ulcerated colitis","justification":""},{"idx":1,"correct":true,"proposition":"Microscopic colitis","justification":""},{"idx":2,"correct":true,"proposition":"Treatment with lansoprazole","justification":""},{"idx":3,"correct":false,"proposition":"Amlodipine treatment","justification":""},{"idx":4,"correct":true,"proposition":"Ileocolic Crohn's disease","justification":""}],"type":"qi"}
{"_id":"annales-2019-qi-105","context":null,"enonce":"Regarding the pre-resumption visit carried out by the occupational physician, it can be carried out on request (one or more possible answers):","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Co-workers","justification":""},{"idx":1,"correct":true,"proposition":"From the general practitioner","justification":""},{"idx":2,"correct":true,"proposition":"From the medical advisor","justification":""},{"idx":3,"correct":true,"proposition":"From the employee","justification":""},{"idx":4,"correct":false,"proposition":"From the employer","justification":""}],"type":"qi"}
{"_id":"annales-2019-qi-115","context":null,"enonce":"About trisomy 21 syndrome: (one or more exact answers)","item":"annales-2019-qi","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"His diagnosis is usually carried out in the balance sheet of a delay in school acquisitions.","justification":""},{"idx":1,"correct":false,"proposition":"Intellectual disability is usually profound","justification":""},{"idx":2,"correct":true,"proposition":"A majority of patients are able to acquire reading","justification":""},{"idx":3,"correct":false,"proposition":"Congenital malformations are constant","justification":""},{"idx":4,"correct":true,"proposition":"The most common digestive malformation is atresia of the duodenum","justification":""}],"type":"qi"}
{"_id":"comportementadd-psy-1","context":null,"enonce":"General:","item":"comportementadd","matiere":"psy","propositions":[{"idx":0,"proposition":"Psychiatric comorbidities affect 50 to 75% of patients with behavioral addictions","correct":true},{"idx":1,"proposition":"Behavioral addictions are disorders of multifactorial origin most often","correct":true},{"idx":2,"proposition":"There is no known therapeutic management today, apart from benzodiazepines","correct":false,"justification":"The therapeutic management of behavioral addictions must be multidisciplinary, involving doctors, psychologists and social workers"},{"idx":3,"proposition":"Behavioral addictions are characterized by the inability to control a behavior despite the occurrence of negative consequences","correct":true},{"idx":4,"proposition":"Given the recent and emerging nature of these disorders, the diagnostic criteria for most of them are currently not defined in a consensual manner.","correct":true}],"type":"custom"}
{"_id":"HBP-uro-0","context":null,"enonce":"Regarding the basics on BPH:","item":"HBP","matiere":"uro","propositions":[{"idx":0,"proposition":"Benign prostatic hyperplasia (BPH) is a common pathology favored by aging","correct":true},{"idx":1,"proposition":"The digital rectal examination (DRE) finds a large prostate (> 20 g), firm, very painful, smooth, irregular, with disappearance of the median fold","correct":false,"justification":"There is a large prostate (> 20 g), firm, INDOLORE, smooth, REGULAR, with disappearance of the median sulcus"},{"idx":2,"proposition":"TR is also an opportunity to screen for prostate cancer","correct":true},{"idx":3,"proposition":"The main chronic complication is erectile dysfunction","correct":false,"justification":"No report. Chronic complications are chronic bladder retention, bladder lithiasis and chronic obstructive renal failure."},{"idx":4,"proposition":"A PSA level > 4 ng \/ mL is an indication to perform prostate biopsies with histopathological examination unless the TR finds a prostate > 20 g","correct":false,"justification":"Despite the increase in PSA with prostate volume, a PSA level > 4 ng\/mL is an indication for prostate biopsies with histopathological examination"}],"type":"custom"}
{"_id":"Kcdermato-onco-2","context":null,"enonce":"Which of the following are true about basal cell carcinoma?","item":"Kcdermato","matiere":"onco","propositions":[{"idx":0,"proposition":"UV is a major risk factor","correct":true},{"idx":1,"proposition":"Metastases are common","correct":false,"justification":"No metastasis. Loco-regional growth"},{"idx":2,"proposition":"It is a benign tumor","correct":false,"justification":"These are indeed carcinomas (= cancer = malignant tumor)"},{"idx":3,"proposition":"They are not serious","correct":false,"justification":"They can be fatal depending on the area where they are located. Their complications (ulceration, bleeding, ...) are not to be taken lightly and require treatment."},{"idx":4,"proposition":"The most common treatment is excision surgery ","correct":true}],"type":"custom"}
{"_id":"Kcdermato-onco-3","context":null,"enonce":"Which of the following is the main precursor of mucosal squamous cell carcinomas?","item":"Kcdermato","matiere":"onco","propositions":[{"idx":0,"proposition":"Actinic keratosis","correct":false,"justification":"It is the main precursor of cutaneous squamous cell carcinomas"},{"idx":1,"proposition":"Leukoplakia","correct":true,"justification":"True, by keratinization of the mucosa (especially the lower labial). These are very limited whitish lesions, asymptomatic, adherent and not bleeding on contact 💉. Curative treatment is surgical."},{"idx":2,"proposition":"Erythroplasia of Queyrat","correct":false,"justification":"Bright red erythematous lesion of the glans, well limited, sometimes discreetly erosive ➡ it is a carcinoma in situ"},{"idx":3,"proposition":"Common wart","correct":false,"justification":"Benign epithelial tumor due to HPV2"},{"idx":4,"proposition":"Condyloma","correct":false,"justification":"Papular lesions localized on the genital areas and related to HPV. So these are STIs. They promote the development of mucosal carcinomas when it is bound to oncogenic papillomaviruses."}],"type":"custom"}
{"_id":"souffleped-cardio-4","context":null,"enonce":"Which of the following are true about ventricular septal defect? ","item":"souffleped","matiere":"cardio","propositions":[{"idx":0,"proposition":"Diastolic murmur","correct":false,"justification":"Holosystolic murmur"},{"idx":1,"proposition":"No irradiation","correct":false,"justification":"Wheel radius irradiation"},{"idx":2,"proposition":"It appears after a few days of life","correct":true},{"idx":3,"proposition":"It is never asymptomatic","correct":false,"justification":"Asymptomatic if small or medium VIC"},{"idx":4,"proposition":"None of these propositions are true","correct":false,"justification":"Only one, I admit it's cow 🐄🐮"}],"type":"custom"}
{"_id":"souffleped-cardio-7","context":null,"enonce":"Regarding the murmur of the ventricular septal defect. Which of the following are true?","item":"souffleped","matiere":"cardio","propositions":[{"idx":0,"proposition":"Holodiastolic breath","correct":false,"justification":"Holosystolic murmur"},{"idx":1,"proposition":"The breath radiates in wheel radius","correct":true,"justification":"None"},{"idx":2,"proposition":"The breath is more intense if the CIV is large","correct":false,"justification":"The breath is more intense if the CIV is small."},{"idx":3,"proposition":"Mesosystolic murmur","correct":false,"justification":"Mesosystolic murmur is characteristic of aortic stricture"},{"idx":4,"proposition":"Holosystolic murmur","correct":true,"justification":"None"}],"type":"custom"}
{"_id":"contraception-gyn-2","context":null,"enonce":"Which of the following are contraindications (IC) to the insertion of an intrauterine device (IUD)?","item":"contraception","matiere":"gyn","propositions":[{"idx":0,"proposition":"Chronic NSAIDs","correct":false,"justification":"Not an IC"},{"idx":1,"proposition":"Nulliparity","correct":false,"justification":"No longer an IC (watch out for possible consequences, including ectopic pregnancy)"},{"idx":2,"proposition":"Valvular heart disease at risk of endocarditis","correct":true},{"idx":3,"proposition":"Pregnancy","correct":true},{"idx":4,"proposition":"Recent gynaecological infection","correct":true}],"type":"custom"}
{"_id":"dlrbuccale-neuro-3","context":null,"enonce":"Regarding migraines:","item":"dlrbuccale","matiere":"neuro","propositions":[{"idx":0,"proposition":"Seizures can start at any age, but 90% start before age 40","correct":true},{"idx":1,"proposition":"The pathophysiology of migraine involves complex genetic factors","correct":true},{"idx":2,"proposition":"Migraine with aura has no impact on comorbidities","correct":false,"justification":"Migraine with aura is an independent risk factor for cerebral infarction especially in women under 45 years of age"},{"idx":3,"proposition":"Migraine without aura is never preceded by prodromes","correct":false,"justification":"The crisis is often preceded by prodromes: irritability, asthenia, drowsiness, hunger, yawning"},{"idx":4,"proposition":"Migraine with aura is preceded or accompanied by transient neurological symptoms that gradually set in","correct":true}],"type":"custom"}
{"_id":"violence-sp-3","context":null,"enonce":"Which of the following are true?","item":"violence","matiere":"sp","propositions":[{"idx":0,"proposition":"Sexual exhibition is the act of imposing a sexual exhibition\/genitals in the public view of a person or group","correct":true},{"idx":1,"proposition":"Sexual exhibition is a crime","correct":false,"justification":"Qualification: misdemeanour"},{"idx":2,"proposition":"The competent court is the criminal court","correct":true},{"idx":3,"proposition":"The limitation period is 30 years","correct":false,"justification":"Limitation period: 3 years 2. SUPPORT 2.1. GENERAL Emergency:"},{"idx":4,"proposition":"Management can be medical","correct":true}],"type":"custom"}
{"_id":"preventionpsy-psy-4","context":null,"enonce":"Regarding risk factors:","item":"preventionpsy","matiere":"psy","propositions":[{"idx":0,"proposition":"Vulnerability to a disorder is a characteristic of a social group","correct":false,"justification":"It is an individual characteristic, linked to the fact that the so-called \"vulnerable\" person has or has been exposed to one or more genetic and\/or environmental risk factors."},{"idx":1,"proposition":"Some risk factors for psychiatric disorders are more particularly related to the age of the individual","correct":true},{"idx":2,"proposition":"Adolescence is a particularly critical period","correct":true},{"idx":3,"proposition":"There are no known risk factors for schizophrenia","correct":false,"justification":"Several risk factors are associated with an increase in the prevalence of schizophrenia such as the age of the father at birth, social and economic status, maternal stress during pregnancy, child abuse, etc."},{"idx":4,"proposition":"Relatives of patients with schizophrenia are more sensitive to risk factors","correct":true}],"type":"custom"}
{"_id":"preventionpsy-psy-6","context":null,"enonce":"What are the factors of psychiatric pathologies?","item":"preventionpsy","matiere":"psy","propositions":[{"idx":0,"proposition":"Consumption of toxic during pregnancy","correct":true},{"idx":1,"proposition":"Workplace harassment","correct":true},{"idx":2,"proposition":"Bereavement \/ Widowhood","correct":true},{"idx":3,"proposition":"Sports activity","correct":false,"justification":"However, sports hyperactivity can be concomitant with certain pathologies, such as TCA, without these being recognized risk factors"},{"idx":4,"proposition":"The high socio-economic level","correct":false,"justification":"Rather the low socio-economic level"}],"type":"custom"}
{"_id":"preventionpsy-psy-10","context":null,"enonce":"What are risk factors for schizophrenia?","item":"preventionpsy","matiere":"psy","propositions":[{"idx":0,"proposition":"The suicide of one of the parents","correct":false},{"idx":1,"proposition":"Birth in winter","correct":true},{"idx":2,"proposition":"Life in an urban environment","correct":true},{"idx":3,"proposition":"Family history in the 3rd degree","correct":false,"justification":"In the first degree only"},{"idx":4,"proposition":"Taking toxic substances in adolescence","correct":true}],"type":"custom"}
{"_id":"antalgie-therapeutique-2","context":null,"enonce":"Which propositions are true?","item":"antalgie","matiere":"therapeutique","propositions":[{"idx":0,"proposition":"The choice of treatment used depends on the cause and type of pain","correct":true},{"idx":1,"proposition":"Neuropathic pain and nociceptive pain are of the same type","correct":false,"justification":"Two types to distinguish"},{"idx":2,"proposition":"Analgesic drugs are used only to treat neuropathic pain","correct":false,"justification":"Analgesic drugs (or analgesics) are used to treat nociceptive pain are classified into three levels by the World Health Organization. Tramadol & morphine can be used also (https:\/\/www.sfetd-douleur.org\/wp-content\/uploads\/2019\/06\/main.pdf)"},{"idx":3,"proposition":"The term 'analgesic' is frequently used for level 1 drugs available in self-medication by the patient (paracetamol, nonsteroidal anti-inflammatory drugs)","correct":true},{"idx":4,"proposition":"The term \"analgesic\" (etymologically \"pain-suppressing\") refers to WHO Level 3","correct":false,"justification":"The term \"analgesic\" (etymologically \"pain-suppressing\") can be used for any analgesic drug, even if the etymology sometimes lacks \"modesty\""}],"type":"custom"}
{"_id":"puberte-gyn-8","context":null,"enonce":"Among these proposals, which correspond to elements of the standard etiological assessment of precocious puberty:","item":"puberte","matiere":"gyn","propositions":[{"idx":0,"proposition":"X-ray of bone age","correct":true,"justification":"Thumb sesamoid of the non-dominant hand = puberty"},{"idx":1,"proposition":"LH\/FSH assay","correct":true,"justification":"As well as a GnRH stimulation test that is possible in girls"},{"idx":2,"proposition":"A prostate ultrasound in the boy","correct":false,"justification":"But a pelvic ultrasound in the girl"},{"idx":3,"proposition":"A hypothalamic-pituitary MRI","correct":true,"justification":"Especially in boys"},{"idx":4,"proposition":"A fasting glycemic assay","correct":false}],"type":"custom"}
{"_id":"puberte-gyn-11","context":null,"enonce":"Regarding delayed pubertal:","item":"puberte","matiere":"gyn","propositions":[{"idx":0,"proposition":"Morsier's Kallmann syndrome is associated with impaired sense of smell","correct":true},{"idx":1,"proposition":"A hypothalamic-pituitary MRI is necessary in the etiological assessment to rule out an organic cause","correct":true},{"idx":2,"proposition":"The cause of delayed puberty is always organic","correct":false,"justification":"The cause of delayed puberty may be functional, e.g. nutritional"},{"idx":3,"proposition":"Respiratory failure can lead to delayed puberty","correct":true},{"idx":4,"proposition":"Celiac disease cannot cause delayed puberty","correct":false,"justification":"If because absorption disorders"}],"type":"custom"}
{"_id":"infdermato-dermato-0","context":null,"enonce":"Regarding impetigo","item":"infdermato","matiere":"dermato","propositions":[{"idx":0,"proposition":"Impetigo is an infection of the epidermis due to a streptococcus most often","correct":false,"justification":"S. Aureus in 90% of cases"},{"idx":1,"proposition":"Impetigo has familial contagiousness","correct":true},{"idx":2,"proposition":"The diagnosis of impetigo is microbiological","correct":false,"justification":"It is clinical"},{"idx":3,"proposition":"Grouping multiple lesions can result in polycyclic closets with circined contours","correct":true},{"idx":4,"proposition":"The classic localization is, in children, the perimeter of the mouth, but all areas of the skin can be affected","correct":true}],"type":"custom"}
{"_id":"Kcrein-onco-0","context":null,"enonce":"Among these proposals of histological types, which correspond to malignant tumors?","item":"Kcrein","matiere":"onco","propositions":[{"idx":0,"proposition":"Clear cell tumour","correct":true,"justification":"Most common malignant tumor"},{"idx":1,"proposition":"Chromophobic cell tumours","correct":true},{"idx":2,"proposition":"Tubulopapillary tumours","correct":true},{"idx":3,"proposition":"Oncocytoma","correct":false,"justification":"Benign tumour"},{"idx":4,"proposition":"Metanephric tumour","correct":false,"justification":"Benign tumour"}],"type":"custom"}
{"_id":"Kcrein-onco-1","context":null,"enonce":"Which of these propositions are true?","item":"Kcrein","matiere":"onco","propositions":[{"idx":0,"proposition":"The Bosniak classification makes it possible to differentiate benign cysts from malignant cysts","correct":true},{"idx":1,"proposition":"The Bosniak classification has 5 categories","correct":false,"justification":"4. The first two tend towards benignity (and the last two tend towards malignancy)"},{"idx":2,"proposition":"Kidney biopsy is often unnecessary","correct":false,"justification":"The resulting grading greatly influences the action to be taken"},{"idx":3,"proposition":"Ultrasound is the reference examination for the extension assessment","correct":false,"justification":"Scanner with contrast injection"},{"idx":4,"proposition":"Kidney tumors are discovered by chance in 50% of cases","correct":false,"justification":"According to the College of Urology, in about 80% of cases"}],"type":"custom"}
{"_id":"hemoptysie-pneumo-2","context":null,"enonce":"Which of the following are true?","item":"hemoptysie","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Blood is bright 🔴 red","correct":true},{"idx":1,"proposition":"Hemoptysis is severe beyond 200 mL","correct":true},{"idx":2,"proposition":"Chest X-ray is irrelevant","correct":false,"justification":"Interesting radiological signs can be found"},{"idx":3,"proposition":"Endoscopy is the second-line examination, after CT angiography","correct":false,"justification":"First-line and systematic"},{"idx":4,"proposition":"Treatment is mostly etiological","correct":true}],"type":"custom"}
{"_id":"Kcsein-onco-6","context":null,"enonce":"Which of the following proposals regarding screening are true?","item":"Kcsein","matiere":"onco","propositions":[{"idx":0,"proposition":"Screening should only be carried out systematically when the patient discovers a suspicious mass on self-examination.","correct":false,"justification":"They are proposed in the absence of clinical signs, on criteria of sex and age"},{"idx":1,"proposition":"Organized mass screening is offered every two years to women aged 50 to 74 when they are at high risk for breast cancer","correct":false,"justification":"Organized mass screening is for all women aged 50 to 74, even without risk factors. In case of risk factor (high risk), patients should be screened individually."},{"idx":2,"proposition":"Individual screening is for women who are at high risk of breast cancer","correct":true},{"idx":3,"proposition":"Organized mass screening is for patients with a BRCA1\/2 mutation","correct":false,"justification":"For the latter, it is an individual screening that is indicated"},{"idx":4,"proposition":"Organized mass screening is performed by bilateral mammography, with a minimum of two incidences and with double reading","correct":true}],"type":"custom"}
{"_id":"Kcsein-onco-9","context":null,"enonce":"Which of the following are true?","item":"Kcsein","matiere":"onco","propositions":[{"idx":0,"proposition":"Adjuvant radiation therapy increases overall survival in patients","correct":true},{"idx":1,"proposition":"The goal of radiotherapy is to reduce the risk of loco-regional relapse","correct":true},{"idx":2,"proposition":"Skin cancers are among the acute side effects","correct":false,"justification":"Chronic side effects"},{"idx":3,"proposition":"Telangiectasias may appear several years later","correct":true},{"idx":4,"proposition":"No proposal is accurate ","correct":false,"justification":"None"}],"type":"custom"}
{"_id":"glomeruloP-nephro-8","context":null,"enonce":"Which of the following proposals should be sought for clinical examination in glomerular nephropathies?","item":"glomeruloP","matiere":"nephro","propositions":[{"idx":0,"proposition":"An abdominal murmur","correct":false,"justification":"Vascular involvement would rather point to vascular nephropathy"},{"idx":1,"proposition":"Polyarthritis","correct":true,"justification":"True, may suggest GI\/rheumatoid purpura nephropathy (GNRP type 2)"},{"idx":2,"proposition":"Oedema of the lower limbs","correct":true},{"idx":3,"proposition":"High blood pressure","correct":true},{"idx":4,"proposition":"Skin photosensitivity","correct":true,"justification":"True, may suggest rheumatoid purpura or lupus (GNRP type 2)"}],"type":"custom"}
{"_id":"BK-infectio-0","context":null,"enonce":"About tuberculosis","item":"BK","matiere":"infectio","propositions":[{"idx":0,"proposition":"Mycobacterium tuberculosis is an acid-alcohol-resistant cocci","correct":false,"justification":"Mycobacteria of Mycobacterium tuberculosis complex (MTBC), acid-alcohol-resistant bacillus (BAAR)"},{"idx":1,"proposition":"Transmission of tuberculosis is air-to-human.","correct":true},{"idx":2,"proposition":"Histology contains an epithelioid and gigantocellular granuloma with caseous necrosis","correct":true},{"idx":3,"proposition":"The main lung lesions are pulmonary cave type","correct":true},{"idx":4,"proposition":"Additional droplet precautions should be applied in case of suspected tuberculosis","correct":false,"justification":"Additional precautions \"AIR\", single room"}],"type":"custom"}
{"_id":"BK-infectio-12","context":null,"enonce":"Which of the following propositions are true regarding the onset of abdominal pain and vomiting in a patient treated with IREP for 6 weeks?","item":"BK","matiere":"infectio","propositions":[{"idx":0,"proposition":"The determination of ALT\/AST is essential","correct":true},{"idx":1,"proposition":"None of the propositions are true","correct":false,"justification":"None"},{"idx":2,"proposition":"Isoniazid may be responsible for hepatic cytolysis, peripheral neuropathy and mental disorders","correct":true},{"idx":3,"proposition":"Oral should be replaced with intravenous","correct":false,"justification":"No impact"},{"idx":4,"proposition":"Pyrazinamide may be responsible for symptoms","correct":true,"justification":"True. Hepatic toxicity and possible hyperuricemia"}],"type":"custom"}
{"_id":"pancreatiteaigue-HGE-1","context":null,"enonce":"Regarding acute pancreatia","item":"pancreatiteaigue","matiere":"HGE","propositions":[{"idx":0,"proposition":"There is no correlation between serum lipasemia levels and pancreatitis severity","correct":true},{"idx":1,"proposition":"The diagnosis of BP is considered certain when a combination of typical pain and elevation > 3 N of lipasemia","correct":true},{"idx":2,"proposition":"If the lipasemia test is performed 48 hours after the onset of pain, it may be less than 3 N","correct":true},{"idx":3,"proposition":"In case of diagnostic certainty, imaging makes it possible to assess the immediate severity","correct":false,"justification":"In case of diagnostic certainty (association pain and typical biological abnormality), no imaging examination is useful for the positive diagnosis and imaging will be performed within 48 to 72 h"},{"idx":4,"proposition":"Only a CT scan should be done in case of diagnostic doubt in the absence of contraindication","correct":true}],"type":"custom"}
{"_id":"pancreatiteaigue-HGE-2","context":null,"enonce":"Concerning acute pacretitis","item":"pancreatiteaigue","matiere":"HGE","propositions":[{"idx":0,"proposition":"If the patient is dehydrated, the injection of contrast medium should be avoided and a CT scan should be done without injection","correct":true},{"idx":1,"proposition":"the CT scan with contrast injection should be done a few days later to assess the severity of BP (cf.","correct":true},{"idx":2,"proposition":"Abdominal ultrasound is of interest for the diagnosis of severity","correct":false,"justification":"Abdominal ultrasound has no interest for positive diagnosis or severity"},{"idx":3,"proposition":"Ultrasound for the diagnosis of vesicular lithiasis and must therefore be done very quickly (as soon as the patient is admitted), and systematically","correct":true},{"idx":4,"proposition":"Abdominal X-ray without preparation has no interest","correct":true}],"type":"custom"}
{"_id":"pancreatiteaigue-urg-0","context":null,"enonce":"Regarding acute pancreatitis","item":"pancreatiteaigue","matiere":"urg","propositions":[{"idx":0,"proposition":"• Severe AP is associated with significant mortality","correct":true},{"idx":1,"proposition":"Multidisciplinary management involving the emergency physician, surgeon, anaesthetist-resuscitator, radiologist and microbiologist is necessary","correct":true},{"idx":2,"proposition":"BP is defined as acute pancreatic inflammation that can affect nearby or distant organs.","correct":true},{"idx":3,"proposition":"Lesions are associated with interstitial oedema, cytosteatonecrosis, necrosis of the pancreatic parenchyma or surrounding tissues","correct":true},{"idx":4,"proposition":"The severity of pancreatitis is defined by the existence of at least three organ failures or a local complication such as necrosis, abscess or pseudocyst","correct":false,"justification":"The severity of pancreatitis is defined by the existence of one or more organ failures or a local complication such as necrosis, abscess or pseudocyst"}],"type":"custom"}
{"_id":"peritonite-infectio-0","context":null,"enonce":"Regarding acute peritonitis","item":"peritonite","matiere":"infectio","propositions":[{"idx":0,"proposition":"Antibiotic therapy targeting commensal bacteria of the digestive tract (mainly enterobacteriaceae, streptococci and anaerobes) has an adjuvant role and may be brief once the surgical procedure has been performed.","correct":true},{"idx":1,"proposition":"Antibiotic therapy is to be started as soon as blood cultures are carried out","correct":true},{"idx":2,"proposition":"Enterococci is not taken into account in the probabilistic treatment of community peritonitis, its pathogenic role is not formally demonstrated","correct":true},{"idx":3,"proposition":"Whatever the result of microbiological samples, the spectrum of antibiotic therapy must always include anaerobic bacteria, because of their frequency and their difficulty of isolation in the laboratory.","correct":true},{"idx":4,"proposition":"Amoxicillin – clavulanic acid probabilistic monotherapy is the treatment of choice","correct":false,"justification":"Amoxicillin – clavulanic acid has no place in probabilistic monotherapy, because of the frequency of acquired resistance of enterobacteriaceae (a quarter of E coli)"}],"type":"custom"}
{"_id":"voiesIV-cardio-4","context":null,"enonce":"Concerning venous surroundings and their complcations","item":"voiesIV","matiere":"cardio","propositions":[{"idx":0,"proposition":"The number of manipulations of the injection routes and aseptic errors on these routes protects against infection","correct":false,"justification":"Obviously the number of manipulations of the injection routes and the aseptic errors on these routes or worse during the preparation of injectable drugs will promote this contamination."},{"idx":1,"proposition":"On the other hand, the catheter cannot be contaminated by hematogenous route during a bacteremic episode","correct":false,"justification":"Finally, the catheter, like any device implanted in the body, can be contaminated hematogenous during a bacteremic episode."},{"idx":2,"proposition":"These central line infections are serious since it is estimated that mortality attributable to intensive care units is in the order of 30%.","correct":false},{"idx":3,"proposition":"These central line infections are serious as mortality in intensive care units is estimated to be in the order of 3%.","correct":true},{"idx":4,"proposition":"An infection can occur early in the subcutaneous compartment of the chamber catheter box which will require its replacement","correct":true}],"type":"custom"}
{"_id":"otite-infectio-1","context":null,"enonce":"About acute otitis media","item":"otite","matiere":"infectio","propositions":[{"idx":0,"proposition":"Antibiotic treatment uses C3G as a first-line treatment, which is the most active molecule on pneumococcus","correct":false,"justification":"Antibiotic treatment uses first-line amoxicillin, which is the most active molecule on pneumococcus"},{"idx":1,"proposition":"All otitis externa are benign","correct":false,"justification":"Except the rare necrotizing otitis externa due to Pseudomonas aeruginosa (mainly on diabetic ground)"},{"idx":2,"proposition":"Cholestomatous otitis is most frequently of infectious origin","correct":false},{"idx":3,"proposition":"Management of cholestoma ear infections is surgical","correct":true},{"idx":4,"proposition":"Purulent acute otitis media corresponds to acute bacterial superinfection of the middle ear","correct":true}],"type":"custom"}
{"_id":"otite-infectio-9","context":null,"enonce":"Which of the following is the recommended duration of antibiotic therapy for acute otitis media in children over two years of age (with severe symptoms)?","item":"otite","matiere":"infectio","propositions":[{"idx":0,"proposition":"5 days","correct":true},{"idx":1,"proposition":"3 days","correct":false,"justification":"False"},{"idx":2,"proposition":"15 days","correct":false,"justification":"False"},{"idx":3,"proposition":"7 days","correct":false,"justification":"False"},{"idx":4,"proposition":"21 days","correct":false,"justification":"False"}],"type":"custom"}
{"_id":"tbmarche-neuro-5","context":null,"enonce":"Regarding walking disorders in Parkinson's disease:","item":"tbmarche","matiere":"neuro","propositions":[{"idx":0,"proposition":"Walking disorders are constant","correct":true},{"idx":1,"proposition":"We can find a walk in small steps","correct":true,"justification":"It is not specific to Parkinson's syndrome. It is also found in chronic hydrocephalus in adults and in incomplete conditions."},{"idx":2,"proposition":"There may be a feast","correct":true,"justification":"Feast = when the patient runs after his center of gravity"},{"idx":3,"proposition":"There is a decomposed U-turn","correct":true},{"idx":4,"proposition":"Freezing (trampling on the spot) appears at the beginning of the evolution of Parkinson's disease","correct":false,"justification":"It is late"}],"type":"custom"}
{"_id":"tbmarche-neuro-6","context":null,"enonce":"Is or are causes of walking disorders with small steps: ","item":"tbmarche","matiere":"neuro","propositions":[{"idx":0,"proposition":"Parkinsonian syndromes","correct":true},{"idx":1,"proposition":"Cerebellar ataxia","correct":false},{"idx":2,"proposition":"Acute hydrocephalus","correct":false,"justification":"Adult Chronicle"},{"idx":3,"proposition":"Gaps","correct":true},{"idx":4,"proposition":"In a person with careful walking and phobia of falling","correct":true}],"type":"custom"}
{"_id":"tbmarche-neuro-15","context":null,"enonce":"What anomaly(s) is\/are likely to cause lameness by greeting?","item":"tbmarche","matiere":"neuro","propositions":[{"idx":0,"proposition":"Default hip extension","correct":true},{"idx":1,"proposition":"Coxopathy","correct":true,"justification":"Default hip extension"},{"idx":2,"proposition":"By a loss of strength of the quadriceps muscle","correct":true,"justification":"Because it is impossible to control the active extension of the knee"},{"idx":3,"proposition":"By a retraction of the hip flexors ","correct":true,"justification":"This causes a hip extension defect (need for a 10° extension for normal walking)"},{"idx":4,"proposition":"STROKE","correct":true}],"type":"custom"}
{"_id":"soinspalrea-anesth-0","context":null,"enonce":"Concerning the main generalities:","item":"soinspalrea","matiere":"anesth","propositions":[{"idx":0,"proposition":"20% of patients who are admitted to intensive care die","correct":true,"justification":"17 25% of deaths according to the College of Pain Pal Care"},{"idx":1,"proposition":"A quarter of patients who die are due to a decision to limit\/stop active therapies","correct":false,"justification":"Half of the deaths are by the LATA"},{"idx":2,"proposition":"Basic comfort and supportive care should be discontinued at the same time as active therapies","correct":false,"justification":"If it is possible to interrupt certain active therapies (curative or substitute), basic comfort and supportive care should always be continued."},{"idx":3,"proposition":"Unreasonable obstinacy is defined as the initiation or continuation of a curative therapy or a diagnostic strategy that is unnecessary and\/or unjustified.","correct":true},{"idx":4,"proposition":"Palliative care has no place in intensive care because patients are unconscious","correct":false}],"type":"custom"}
{"_id":"soinspalrea-anesth-2","context":null,"enonce":"Which proposals are correct?","item":"soinspalrea","matiere":"anesth","propositions":[{"idx":0,"proposition":"The intention of the decision is not to cause death but to let the physiological process take place without technical or drug intervention deemed of no benefit to the patient.","correct":true},{"idx":1,"proposition":"The cessation of active therapies is defined by the interruption of one or more treatments including organ replacement techniques ensuring artificial life support","correct":true},{"idx":2,"proposition":"The decision to limit or stop active therapies is a cessation of care","correct":false,"justification":"The decision to limit or stop active therapies is in no way a cessation of care and abandonment of the patient: comfort care, pain management, etc."},{"idx":3,"proposition":"LATA is not a palliative strategy","correct":false,"justification":"Yes, step to stop care"},{"idx":4,"proposition":"Financial or structural arguments (need for resuscitation space) have no place in decision-making","correct":true}],"type":"custom"}
{"_id":"vertige-neuro-2","context":null,"enonce":"Regarding vestibular nystagmus and vestibular examination:","item":"vertige","matiere":"neuro","propositions":[{"idx":0,"proposition":"Vestibular examination is based on the detection of oculomotor abnormalities and vestibular ataxia","correct":true},{"idx":1,"proposition":"Nystagmus is a totally irregular eye movement back and forth of the eyes","correct":false,"justification":"It is regular and composed of at least one slow phase"},{"idx":2,"proposition":"The direction of beating of a nystagmus is given by that of the rapid phase","correct":true,"justification":"Convention because more instinctive under consideration"},{"idx":3,"proposition":"Vestibular nystagmus appears only in the eccentration of the gaze","correct":false,"justification":"Vestibular nystagmus may be spontaneous in the position of the gaze straight ahead, or appear only under certain search conditions: eccentration of the gaze: peripheral vestibular nystagmus is often found in the direction of the rapid phase"},{"idx":4,"proposition":"Peripheral vestibular nystagmus is attenuated by eye fixation","correct":true}],"type":"custom"}
{"_id":"LLC-onco-4","context":null,"enonce":"Which of the following proposals can confirm the diagnosis of chronic lymphocytic leukemia?","item":"LLC","matiere":"onco","propositions":[{"idx":0,"proposition":"Karyotype","correct":false,"justification":"False"},{"idx":1,"proposition":"Myelogram","correct":false,"justification":"Useless"},{"idx":2,"proposition":"Bone marrow biopsy","correct":false,"justification":"Useless"},{"idx":3,"proposition":"Immunophenotyping of blood lymphocytes","correct":true,"justification":"True, essential for diagnosis in addition to NFS"},{"idx":4,"proposition":"Lymphocyte analysis by molecular biology","correct":false,"justification":"For prognostic factors"}],"type":"custom"}
{"_id":"SMP-onco-2","context":null,"enonce":"Which of the following are possible evolutions of CML (Chronic Myeloid Leukemia)?","item":"SMP","matiere":"onco","propositions":[{"idx":0,"proposition":"Acceleration phase","correct":true,"justification":"True, after 12-18 months of chronic phase"},{"idx":1,"proposition":"Syndrome de Richter","correct":false,"justification":"In LLCs"},{"idx":2,"proposition":"Acutization phase","correct":true,"justification":"True, it's the passage in MLL"},{"idx":3,"proposition":"Transformation to acute lymphocytic leukemia","correct":true,"justification":"In MLL most often. But ALL is also possible"},{"idx":4,"proposition":"Transformation into myeloid splenomegaly","correct":false,"justification":"Not described in the college"}],"type":"custom"}
{"_id":"SMP-onco-9","context":null,"enonce":"Which of the following are true?","item":"SMP","matiere":"onco","propositions":[{"idx":0,"proposition":"In CML, there is no increase in hemoglobin","correct":true,"justification":"True, it is normal or low"},{"idx":1,"proposition":"There is polycythemia in essential thrombocythemia","correct":false,"justification":"No, it is a criterion of distinction with primary polycythemia (or polycythemia vera)"},{"idx":2,"proposition":"Sedimentation Rate (ESR) is falsely zero or very low in polycythemia vera","correct":true,"justification":"True, because of the large excess of red blood cells and the hyperviscosity induced by them"},{"idx":3,"proposition":"Hydroxycarbamide gives quite frequently mucocutaneous lesions","correct":false,"justification":"False"},{"idx":4,"proposition":"Ruxolitinib is a kinase inhibitor targeting JAK1 and JAK2","correct":true}],"type":"custom"}
{"_id":"hypoGly-endoc-2","context":null,"enonce":"Regarding carbohydrate metabolism hormones:","item":"hypoGly","matiere":"endoc","propositions":[{"idx":0,"proposition":"Insulin is the main hyperglycemic factor","correct":false,"justification":"Insulin is one of the only hypoglycemic hormones, its concentration rises after the meal and decreases during fasting"},{"idx":1,"proposition":"IGF1 is a hyperglycemic hormone","correct":false,"justification":"iGF 1 and iGF 2 are growth factors with hypoglycemic properties when their concentrations are very high (pharmacological or tumoral)"},{"idx":2,"proposition":"IGF2 is hypoglycemic at supraphysiological concentrations","correct":true},{"idx":3,"proposition":"GH has a hyperglycemic effect","correct":true},{"idx":4,"proposition":"Cortisol has a hyperglycemic effect","correct":true}],"type":"custom"}
{"_id":"compressionmed-neuro-2","context":null,"enonce":"Regarding the assessment of the severity of impairments:","item":"compressionmed","matiere":"neuro","propositions":[{"idx":0,"proposition":"During paraplegia, the functioning of the upper limbs is preserved, but depending on the level of the lesion, the trunk, lower limbs and pelvic organs can be affected.","correct":true},{"idx":1,"proposition":"Standardized assessment of incomplete lesions based on ASIA standard","correct":true},{"idx":2,"proposition":"The rating (from 0 to 5) of each muscle\/key function is done according to the motor testing of the Medical Research Council or MRC is part of the ASIA standard","correct":true},{"idx":3,"proposition":"– grade B: preservation of a sensory function but not of the motor function at the level of the last sacral segments (S4-S5)","correct":true},{"idx":4,"proposition":"– grade D: motor preservation below the neurological level of the lesion with at least half of the key muscles with a rating greater than 3","correct":true}],"type":"custom"}
{"_id":"diarrheeaigue-HGE-2","context":null,"enonce":"Regarding acute diarrhoea","item":"diarrheeaigue","matiere":"HGE","propositions":[{"idx":0,"proposition":"Diarrhoea occurring during antibiotic treatment is by definition antibiotic diarrhoea","correct":true},{"idx":1,"proposition":"More than 10% of subjects receiving antiobiotics have transit changes","correct":true},{"idx":2,"proposition":"In front of a dysenteric syndrome, it is necessary to prescribe a CRP, a stool culture and a blood count","correct":true},{"idx":3,"proposition":"In front of any diarrhea the signs of dehydration should be sought","correct":true},{"idx":4,"proposition":"Acute diarrhea is nosocomial when it occurs within 2 days of admission","correct":false,"justification":"must occur more than three days after admission"}],"type":"custom"}
{"_id":"rachialgie-rhumato-5","context":null,"enonce":"Which of the following proposals are part of the initial management of common low back pain?","item":"rachialgie","matiere":"rhumato","propositions":[{"idx":0,"proposition":"NFS-CRP","correct":false,"justification":"No additional examination in the absence of a red flag"},{"idx":1,"proposition":"Vertebral x-rays of front and profile","correct":false,"justification":"No additional examination in the absence of a red flag"},{"idx":2,"proposition":"NSAIDs if needed","correct":true},{"idx":3,"proposition":"Paracetamol","correct":true},{"idx":4,"proposition":"Strict bed rest","correct":false,"justification":"No rest to prescribe. The latter only seems to increase the duration of low back pain"}],"type":"custom"}
{"_id":"coma-urg-1","context":null,"enonce":"Which of the following are differential diagnoses of coma? ","item":"coma","matiere":"urg","propositions":[{"idx":0,"proposition":"Locked-in syndrome","correct":false,"justification":"True, lesions of the foot of the protrusion"},{"idx":1,"proposition":"Akinetic mutism","correct":false,"justification":"True, bilateral internal or peduncular frontal lesions"},{"idx":2,"proposition":"Post-critical phase of a comitial crisis","correct":false,"justification":"True, usually quickly resolving"},{"idx":3,"proposition":"Psychogenic coma","correct":false,"justification":"True, << the simulation of disorders of consciousness is not exceptional >> according to the college, but it is necessary to be << extremely rigorous>>"},{"idx":4,"proposition":"All propositions are true","correct":true}],"type":"custom"}
{"_id":"coma-urg-2","context":null,"enonce":"From what value of the Glasgow score are we talking about Coma?","item":"coma","matiere":"urg","propositions":[{"idx":0,"proposition":"5","correct":false,"justification":"False"},{"idx":1,"proposition":"6","correct":false,"justification":"False"},{"idx":2,"proposition":"11","correct":false,"justification":"False"},{"idx":3,"proposition":"7","correct":true,"justification":"True."},{"idx":4,"proposition":"9","correct":false,"justification":"False"}],"type":"custom"}
{"_id":"IRenA-urg-6","context":null,"enonce":"Which of the following proposals regarding Renal Puncture-Biopsy (PBR) are true?","item":"IRenA","matiere":"urg","propositions":[{"idx":0,"proposition":"Severe hypertension is a contraindication to PBR","correct":true},{"idx":1,"proposition":"It is never necessary in diabetics","correct":false,"justification":"Always indicated, unless typical presentation"},{"idx":2,"proposition":"This is an emergency in rapidly progressive glomerulonephritis (GNRP)","correct":true},{"idx":3,"proposition":"None of these propositions are true","correct":false,"justification":"None"},{"idx":4,"proposition":"Complications of PBR can, very rarely, go as far as the death of the patient","correct":true,"justification":"True, in less than one case per 1000"}],"type":"custom"}
{"_id":"tbneuroSegeria-geria-0","context":null,"enonce":"Regarding the basics:","item":"tbneuroSegeria","matiere":"geria","propositions":[{"idx":0,"proposition":"Taste, smell and vision are achieved with the same intensity with aging","correct":false,"justification":"Variable and multifactorial intensity"},{"idx":1,"proposition":"A taste deficit can lead to AEG","correct":true,"justification":"Anorexia, then Weight loss, then Asthenia"},{"idx":2,"proposition":"A hearing impairment can lead to cognitive disorders","correct":true,"justification":"By extreme withdrawal"},{"idx":3,"proposition":"Vision impairment can lead to depression","correct":true,"justification":"By isolation"},{"idx":4,"proposition":"There are no effective treatments for these neurosensory disorders","correct":false,"justification":"Many treatment options exist"}],"type":"custom"}
{"_id":"angine-infectio-6","context":null,"enonce":"Which of the following are complications of nasopharyngitis?","item":"angine","matiere":"infectio","propositions":[{"idx":0,"proposition":"Purulent acute otitis media","correct":true},{"idx":1,"proposition":"Purulent conjunctivitis","correct":true},{"idx":2,"proposition":"Acute sinusitis ","correct":true,"justification":"True, the rarest complication"},{"idx":3,"proposition":"Purulent meningitis","correct":false},{"idx":4,"proposition":"Acute bronchitis","correct":false}],"type":"custom"}
{"_id":"OH-gastro-4","context":null,"enonce":"Which propositions are true?","item":"OH","matiere":"HGE","propositions":[{"idx":0,"proposition":"Alcohol increases the epileptogenic threshold","correct":false,"justification":"Alcohol lowers the epileptogenic threshold"},{"idx":1,"proposition":"Gayet-Wernicke encephalopathy is due to vitamin B1 deficiency","correct":true},{"idx":2,"proposition":"Wernicke-Korsakoff encephalopathy is due to vitamin B1 deficiency","correct":true,"justification":"Be careful, Gayet-Wernicke encephalopathy is also called Wernicke-Korsakoff (not to be confused with Korsakoff syndrome)"},{"idx":3,"proposition":"Myelinosis centropontin is due to vitamin B9 deficiency","correct":false,"justification":"Centropontin myelinosis is due to too rapid correction of deep hyponatremia"},{"idx":4,"proposition":"Pellagrean encephalopathy is due to vitamin B12 deficiency","correct":false,"justification":"Pellagrese encephalopathy is due to vitamin PP deficiency (= Vitamin B3)"}],"type":"custom"}
{"_id":"drogues-psy-7","context":null,"enonce":"Regarding cocaine:","item":"drogues","matiere":"psy","propositions":[{"idx":0,"proposition":"There are two patch-type treatments for cocaine but neither has been shown to be effective.","correct":false,"justification":"No medicinal product has a marketing authorisation (MA) in France for the treatment of harmful use and dependence"},{"idx":1,"proposition":"Cocaine is extracted from coca leaves, grown mainly in South America, Indonesia and eastern Africa.","correct":true},{"idx":2,"proposition":"Cocaine is the most frequently used illicit stimulant substance in Europe","correct":true},{"idx":3,"proposition":"The average age of first consumption is 16 years","correct":false,"justification":"The average age of first consumption is 22 years"},{"idx":4,"proposition":"On average, men are three to four times more consumers than women","correct":true}],"type":"custom"}
{"_id":"pericardite-cardio-3","context":null,"enonce":"Regarding viral pericarditis","item":"pericardite","matiere":"cardio","propositions":[{"idx":0,"proposition":"Acute viral pericarditis is the most common, but rarely proven, etiology related to viral infection and associated immune response.","correct":true},{"idx":1,"proposition":"The course is most often favorable in viral pericarditis","correct":true},{"idx":2,"proposition":"The recidivism rate is low and is around 3 to 5%","correct":false,"justification":"Recurrence is common, ranging from 30% to 50% of cases, and is the most common complication"},{"idx":3,"proposition":"The occurrence of tamponade or progression to pericardial constriction is rare","correct":true},{"idx":4,"proposition":"Treatment of recurrent viral pericarditis remains purely symptomatic","correct":false,"justification":"In some forms of recurrent chronic pericarditis, after viral diagnosis, the prescription of specific treatments (immunoglobulins, interferon α) is discussed"}],"type":"custom"}
{"_id":"psyado-psy-4","context":null,"enonce":"Which propositions are true?","item":"psyado","matiere":"psy","propositions":[{"idx":0,"proposition":"A diagnosis of a behavioural disorder can only be made after at least 3 months","correct":false,"justification":"Minimum duration = 6 months"},{"idx":1,"proposition":"ITEP orientation requires MDPH notification","correct":true},{"idx":2,"proposition":"A diagnosis of a behavioural disorder can only be made after at least 6 months","correct":true},{"idx":3,"proposition":"PAP orientation requires MDPH notification","correct":false,"justification":"MDPH notification is required for WEPP and ITEP only"},{"idx":4,"proposition":"The AEEH requires the completion of an MDPH dossier","correct":true}],"type":"custom"}
{"_id":"retardSP-ped-6","context":null,"enonce":"Which of these proposals can cause weight stunting with a change of corridor on the curve?","item":"retardSP","matiere":"ped","propositions":[{"idx":0,"proposition":"Anorexia nervosa","correct":true},{"idx":1,"proposition":"IBD","correct":true},{"idx":2,"proposition":"Hypothyroidism","correct":false,"justification":"Rather a statural delay"},{"idx":3,"proposition":"Celiac disease","correct":true},{"idx":4,"proposition":"Hypocorticism","correct":false,"justification":"Hypercorticism can cause a statural delay"}],"type":"custom"}
{"_id":"dlrphysiopath-neuro-7","context":null,"enonce":"Which of these substances are analgesics?","item":"dlrphysiopath","matiere":"neuro","propositions":[{"idx":0,"proposition":"Glutamate","correct":false,"justification":"Activates neurons of the extra-lemniscale pathway"},{"idx":1,"proposition":"Aspartate","correct":false,"justification":"Activates neurons of the extra-lemniscale pathway"},{"idx":2,"proposition":"Substance P","correct":false,"justification":"Promotes activation of neurons of the extra-lemniscale pathway"},{"idx":3,"proposition":"The NA","correct":true},{"idx":4,"proposition":"Serotonin","correct":true}],"type":"custom"}
{"_id":"DE-uro-2","context":null,"enonce":"Regarding pathophysiology:","item":"DE","matiere":"uro","propositions":[{"idx":0,"proposition":"PDE5 inhibitors thus promote the maintenance and quality of erection","correct":true},{"idx":1,"proposition":"Smooth muscle relaxation allows the opening of sinusoid spaces and inhibits erection","correct":false,"justification":"The opening of the sinusoid spaces allows blood flow, and therefore erection"},{"idx":2,"proposition":"Neural NO triggers smooth muscle cell contraction and allows erection","correct":false,"justification":"Neural NO triggers smooth muscle cell relaxation"},{"idx":3,"proposition":"When the spaces are filled, the compression of the subalbugineal veins will oppose the exit of the blood and allow to obtain the rigidity of the penis (veno-occlusive mechanism)","correct":true},{"idx":4,"proposition":"One in nine men has erectile dysfunction after age 40","correct":false,"justification":"One in three men: more than 30%!"}],"type":"custom"}
{"_id":"DE-uro-4","context":null,"enonce":"Regarding support:","item":"DE","matiere":"uro","propositions":[{"idx":0,"proposition":"Residual erectile capacity is a factor in good prognosis","correct":true},{"idx":1,"proposition":"Sleep disorders can contribute to ED","correct":true},{"idx":2,"proposition":"There is no known iatrogenic cause of ED.","correct":false,"justification":"Drug iatrogenesis is often at the origin of ED: antidepressants, neuroleptics, non-selective beta-blockers, antihypertensives (antialdosterone and thiazide diuretics), 5-α reductase inhibitors and antiandrogens"},{"idx":3,"proposition":"The digital rectal examination for prostate enlargement or prostate cancer is performed after age 50, or from age 45 if there is a family history","correct":true},{"idx":4,"proposition":"An intracavernous injection pharmacological test is useful if PDE5 inhibitors are ineffective or if anrectile dysfunction is carried out","correct":true}],"type":"custom"}
{"_id":"pso-dermato-5","context":null,"enonce":"Regarding the diagnosis:","item":"pso","matiere":"dermato","propositions":[{"idx":0,"proposition":"Psoriasis is not contagious","correct":true},{"idx":1,"proposition":"Psoriasis is not itchy","correct":false,"justification":"Pruritus is present during flare-ups in 50% of cases"},{"idx":2,"proposition":"Psoriasis regresses without leaving a scar","correct":true},{"idx":3,"proposition":"Psoriasis is painless","correct":false,"justification":"Lesions can be painful, especially on palms and soles where cracks may appear"},{"idx":4,"proposition":"Scalp psoriasis is one of the leading causes of alopecia","correct":false,"justification":"It is rarely the cause of hair loss"}],"type":"custom"}
{"_id":"choc-urg-1","context":null,"enonce":"Which propositions are true?","item":"choc","matiere":"urg","propositions":[{"idx":0,"proposition":"The diagnosis of the type of shock is clinical and paraclinical (using examinations quickly achievable)","correct":true},{"idx":1,"proposition":"The treatment of shock is based on specific treatments of the type of shock","correct":true},{"idx":2,"proposition":"Shock is defined as acute circulatory failure that permanently alters oxygenation and metabolism of tissues and organs.","correct":true},{"idx":3,"proposition":"Cardiac output (CD) is a function of total blood volume and blood pressure","correct":false,"justification":"At the macrocirculatory level: Cardiac output (DC) is a function of preload, inotropism, afterload and heart rate (HR)"},{"idx":4,"proposition":"MPA is schematically the result of DC and systemic vascular resistance","correct":true}],"type":"custom"}
{"_id":"classifpsy-psy-4","context":null,"enonce":"Semiological terms in psychiatry:","item":"classifpsy","matiere":"psy","propositions":[{"idx":0,"proposition":"Derealization is a modified perception of the world with a sense of strangeness","correct":true},{"idx":1,"proposition":"Depersonalization is the act of changing one's personality in the acute phase of schizophrenia","correct":false,"justification":"Depersonalization is a perception of oneself as different and strange and a sense of being an observer of one's own mental functioning."},{"idx":2,"proposition":"Hypoprosexia is a difficulty concentrating","correct":true},{"idx":3,"proposition":"Paramnesia is the creation of false memories","correct":false,"justification":"Paramnesia is decontextualized or distorted recollection"},{"idx":4,"proposition":"Affectivity includes emotions and mood","correct":true}],"type":"custom"}
{"_id":"GEU-gyn-3","context":null,"enonce":"Regarding the diagnosis of GEU:","item":"GEU","matiere":"gyn","propositions":[{"idx":0,"proposition":"Functional signs may be pelvic pain only","correct":true},{"idx":1,"proposition":"Pelvic pain is always lateralized on the GEU side","correct":false,"justification":"lateralized or not on the GEU side"},{"idx":2,"proposition":"All EMGs are symptomatic","correct":false,"justification":"Note that GEU can be asymptomatic"},{"idx":3,"proposition":"The speculum makes it possible to specify the endouterine origin of bleeding","correct":true},{"idx":4,"proposition":"The vaginal touch finds a uterus less voluminous than the theoretical duration of gestation would like","correct":true}],"type":"custom"}
{"_id":"GEU-gyn-12","context":null,"enonce":"Regarding the medical treatment of GEU:","item":"GEU","matiere":"gyn","propositions":[{"idx":0,"proposition":"Drug therapy is considered when the βHCG level is less than or equal to 10,000 IU\/L","correct":false,"justification":"drug therapy (methotrexate 1 mg\/kg) may be discussed with the patient provided that: • none of the above 3 severity criteria is present, • the βHCG level is less than 5,000 IU\/L, • the patient has no contraindication to methotrexate (respiratory failure"},{"idx":1,"proposition":"Respiratory failure is one of the contraindications of methotrexate","correct":true},{"idx":2,"proposition":"Methotrexate has significant side effects on slow-reproducing cell tissues such as the heart and brain","correct":false,"justification":"This explains the precautions for use and the side effects occurring on rapidly dividing cell tissues: bone marrow, gastrointestinal mucosa, respiratory epithelium"},{"idx":3,"proposition":"The patient should be informed of adverse reactions to methotrexate such as nausea and diahrrea","correct":true},{"idx":4,"proposition":"The correct decrease of βHCG is monitored once a month","correct":false,"justification":"The correct decrease of βHCG is monitored once a week, the risk of treatment failure being about 25%\""}],"type":"custom"}
{"_id":"GEU-gyn-15","context":null,"enonce":"Which of the following are risk factors for UEM?","item":"GEU","matiere":"gyn","propositions":[{"idx":0,"proposition":"Upper genital infections (salpingitis and endometritis), the most common germ of which is Neisseria gonorrhoeae ","correct":false,"justification":"The most common germ is Chlamydia trachomatis.\r\nIt is the first risk factor for alteration of tubal motility."},{"idx":1,"proposition":"Tobacco","correct":true,"justification":"Dose-effect relationship. This is the 2nd risk factor."},{"idx":2,"proposition":"The IUD","correct":true},{"idx":3,"proposition":"The microprogestin-only pill","correct":true},{"idx":4,"proposition":"Tuberculosis","correct":true}],"type":"custom"}
{"_id":"GEU-gyn-17","context":null,"enonce":"Regarding the surgical treatment of ectopic pregnancy. Which of the following are true?","item":"GEU","matiere":"gyn","propositions":[{"idx":0,"proposition":"There are 2 therapeutic options: conservative treatment (salpingotomy) and radical treatment (salpingectomy)","correct":true,"justification":"True. Salpingotomy is the opening of a fallopian tube. It is often performed under laparoscopy, but also by laparotomy. It allows, among other things, to evacuate an ectopic pregnancy by aspiration, when the state of the tube allows its conservation. A salpingectomy is removal of one or more fallopian tubes."},{"idx":1,"proposition":"Surgical treatment is indicated as a first-line treatment in case of hemodynamically unstable patient","correct":true},{"idx":2,"proposition":"Surgical treatment is indicated as a first-line treatment for β-HCG > 500 mIU\/mL","correct":false},{"idx":3,"proposition":"Surgical treatment is indicated as a first-line treatment in case of > 2 cm haematosalpinx on ultrasound","correct":false,"justification":"Hematosalpinx > 4cm on ultrasound"},{"idx":4,"proposition":"Surgical treatment is indicated as a first-line treatment in case of contraindication to drug treatment with methotrexate","correct":true,"justification":"True, CI as severe renal impairment or severe hepatic impairment."}],"type":"custom"}
{"_id":"GEU-gyn-18","context":null,"enonce":"Regarding methotrexate treatment for GEU. Which of the following proposals is\/are the contraindication(s) to treatment?","item":"GEU","matiere":"gyn","propositions":[{"idx":0,"proposition":"Thrombocytopenia at 60,000 G\/L","correct":false,"justification":"50,000 G\/L. Remember that methotrexate is an anti-metabolic treatment of DNA, so it will limit the production of blood cells by the bone marrow. It is not uncommon for it to cause leukopenia or thrombocytopenia."},{"idx":1,"proposition":"Anemia with Hb < 9 g\/L","correct":true,"justification":"True, especially in coronary artery patients (in whom transfusion threshold = 10 g\/dL)"},{"idx":2,"proposition":"Severe liver injury","correct":true,"justification":"True, just like kidney damage"},{"idx":3,"proposition":"Symptomatic patient (pain)","correct":true},{"idx":4,"proposition":"Leukopenia < 4.5 g\/L","correct":false}],"type":"custom"}
{"_id":"atherome-cardio-2","context":null,"enonce":"About atherosclerosis","item":"atherome","matiere":"cardio","propositions":[{"idx":0,"proposition":"Atherosclerosis is a combination of reshuffling of the weed of large and medium-sized arteries, all accompanied by changes in the media","correct":false,"justification":"The weed is respected. It is the media and the intima that are being reshuffled."},{"idx":1,"proposition":"The accumulation of low-density lipoproteins in the intima is the first histological abnormality found in the formation of atheroma","correct":true,"justification":"The accumulation of LDLc then attracts monocytes"},{"idx":2,"proposition":"Lipid streak is formed by the accumulation of foam cells","correct":true,"justification":"Foam cells are macrophages that have endocytized LDLc."},{"idx":3,"proposition":"In the stages of atheroma formation, there is a migration of smooth muscle fibers to the intima.","correct":true,"justification":"As well as a differentiation of these fibers"},{"idx":4,"proposition":"An old atheromatous plaque is more unstable than a young plaque","correct":false,"justification":"The fibrous screed is stronger in the case of an old plate. The rupture is all the more likely as the plaque is young, very lipidic and very inflammatory"}],"type":"custom"}
{"_id":"atherome-cardio-5","context":null,"enonce":"Which of the following are areas at high risk of atheroma?","item":"atherome","matiere":"cardio","propositions":[{"idx":0,"proposition":"Abdominal aorta","correct":false,"justification":"2 risk areas: areas of mechanical stress and bifurcation zones of large arteries (carotid, subclavicular, vertebral, coronary, etc.)"},{"idx":1,"proposition":"Bifucations of carotid arteries","correct":true},{"idx":2,"proposition":"Coronary arteries","correct":true},{"idx":3,"proposition":"Renal arteries (excluding bifurcation)","correct":false,"justification":"False"},{"idx":4,"proposition":"All arteries","correct":false,"justification":"False"}],"type":"custom"}
{"_id":"meningite-neuro-10","context":null,"enonce":"Regarding contraindications to lumbar puncture","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"proposition":"A Glasgow < 15 is always a contraindication to lumbar puncture","correct":false,"justification":"With the new recommendations, a Glasgow < 15 is not a contraindication"},{"idx":1,"proposition":"Taking antiplatelet agents is a contraindication to PL","correct":false,"justification":"That anticoagulants"},{"idx":2,"proposition":"It is necessary to make a lumbar puncture in front of a purpura fulminans","correct":false,"justification":"Often, PL is not possible because purpura fulminancs is associated with hemostate disorders with DIC, and hemodynamic disorders, which are contraindications"},{"idx":3,"proposition":"Thrombocytopenia < 100 G \/ L is a contraindication to PL","correct":false},{"idx":4,"proposition":"An abnormality of pupillary tone is a contraindication to PL","correct":true,"justification":"This is a sign suggestive of cerebral engagement by damage to the 3rd cranial nerve (oculomotor)"}],"type":"custom"}
{"_id":"meningite-neuro-16","context":null,"enonce":"Regarding the biological analysis of purulent meningitis:","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"proposition":"Purulent meningitis is defined as purulent fluid or fluid rich in PNN (> 50%) and hypoglycorachia","correct":true},{"idx":1,"proposition":"If a gram-positive diplococcus is found on direct examination, treatment should be treated with IV C3G and dexamethasone","correct":true,"justification":"It is a pneumococcus"},{"idx":2,"proposition":"If a gram-positive bacillus is found on direct examination, treatment should be treated with C3G IV and dexamethasone","correct":false,"justification":"This is listeria that is resistant to C3G. It must be treated with amoxicillin + gentamicin."},{"idx":3,"proposition":"In case of beta-lactam allergy and the presence of a gram-positive bacillus, treatment should be treated with vancomycin and rifampicin","correct":false,"justification":"Treatment should be taken with vancomycin + rifampicin + cotrimoxazole"},{"idx":4,"proposition":"If gram-negaitf diplococcus is found, treatment with C3G IV and dexamethasone should be treated","correct":true,"justification":"Gram-negative diplococcus = meningococcal"}],"type":"custom"}
{"_id":"responsabilite-sp-0","context":null,"enonce":"Regarding medical liability","item":"responsabilite","matiere":"sp","propositions":[{"idx":0,"proposition":"During clinical practice, any physician may have his responsibility engaged","correct":true,"justification":"1"},{"idx":1,"proposition":"As a citizen, he is accountable to society for his actions","correct":true,"justification":"1"},{"idx":2,"proposition":"The doctor may be sanctioned by a criminal law court","correct":true,"justification":"1"},{"idx":3,"proposition":"Criminal liability cannot lead to punishment","correct":false,"justification":"Criminal Responsibilities Responsibility leading to a SANCTION: Ordinal\/disciplinary responsibility"},{"idx":4,"proposition":"Civil liability can lead to compensation","correct":true,"justification":"TRUE\""}],"type":"custom"}
{"_id":"responsabilite-sp-1","context":null,"enonce":"Which of these responsibilities lead to compensation?","item":"responsabilite","matiere":"sp","propositions":[{"idx":0,"proposition":"Civil liability","correct":true,"justification":"2 main types of responsibilities lead to patient compensation: civil (in liberal) and administrative (in hospital)"},{"idx":1,"proposition":"Criminal liability","correct":false,"justification":"Leads to a doctor's sanction"},{"idx":2,"proposition":"Ordinal responsibility","correct":false,"justification":"Sanctions the doctor"},{"idx":3,"proposition":"Disciplinary responsibility","correct":false},{"idx":4,"proposition":"Administrative responsibility","correct":true,"justification":"In the hospital sector\""}],"type":"custom"}
{"_id":"ADP-hemato-1","context":null,"enonce":"Regarding superficial lymphadenopathy:","item":"ADP","matiere":"hemato","propositions":[{"idx":0,"proposition":"The clinical examination must be supplemented by a search for hepato-splenomegaly","correct":true},{"idx":1,"proposition":"A hard consistency and a fixed character (= not mobile) are rather in favor of an infectious etiology","correct":false,"justification":"A hard consistency and a fixed character (= not mobile) are rather in favor of a neoplastic etiology"},{"idx":2,"proposition":"Sus clavicular lymphadenopathy is frequently associated with a neoplastic cause (thoracic if left supraclavicular lymphadenopathy and abdominopelvic lymphadenopathy if right lymphadenopathy)","correct":false,"justification":"Thoracic if right supraclavicular lymphadenopathy and abdominopelvic if left lymphadenopathy"},{"idx":3,"proposition":"An axillary lymphadenopathy evokes in priority: cat scratch disease, breast cancer or metastases, inflammatory reaction to a foreign body (breast prosthesis)","correct":true},{"idx":4,"proposition":"Epitrochlear lymphadenopathy should be tested for local infection of the hand and forearm","correct":true}],"type":"custom"}
{"_id":"LA-onco-3","context":null,"enonce":"What are the biological signs that can be found?","item":"LA","matiere":"onco","propositions":[{"idx":0,"proposition":"Regenerative anemia","correct":false,"justification":"Anemia is aregenerative since the involvement is central"},{"idx":1,"proposition":"Normocytic anemia","correct":true},{"idx":2,"proposition":"Thrombocytopenia","correct":true},{"idx":3,"proposition":"CIVD","correct":true},{"idx":4,"proposition":"PNN leukocytosis","correct":false,"justification":"Instead, neutropenia is found"}],"type":"custom"}
{"_id":"LA-onco-15","context":null,"enonce":"What type of acute leukemia is at high risk of being complicated by DIC?","item":"LA","matiere":"onco","propositions":[{"idx":0,"proposition":"LAL de type B","correct":false,"justification":"False"},{"idx":1,"proposition":"LAL de type T","correct":false,"justification":"False"},{"idx":2,"proposition":"LAM3","correct":true,"justification":"True. Also called promyelocytic."},{"idx":3,"proposition":"Promyelocytic AML","correct":true,"justification":"True. LAM3 = promyeolcytic."},{"idx":4,"proposition":"Monoblastic AML","correct":false,"justification":"LAM5"}],"type":"custom"}
{"_id":"SMD-onco-7","context":null,"enonce":"Which of the following are true?","item":"SMD","matiere":"onco","propositions":[{"idx":0,"proposition":"Myelodysplastic syndromes frequently occur in people under the age of 50","correct":false,"justification":"Most appear after age 50"},{"idx":1,"proposition":"Myelodysplastic syndromes can be de novo or secondary","correct":true},{"idx":2,"proposition":"Cytogenetic abnormalities in myeloid cells have prognostic value","correct":true},{"idx":3,"proposition":"The number of peripheral cytopenias have prognostic value","correct":true},{"idx":4,"proposition":"Hematopoietic stem cell transplantation is the only currently known curative treatment","correct":true}],"type":"custom"}
{"_id":"Kcphysiopath-onco-1","context":null,"enonce":"Which of these propositions are true?","item":"Kcphysiopath","matiere":"onco","propositions":[{"idx":0,"proposition":"Cancer cells carry multiple genetic abnormalities","correct":true},{"idx":1,"proposition":"Somatic mutations on drivers can be the target of certain therapeutic molecules","correct":true},{"idx":2,"proposition":"Somatic mutations on drivers are often the same","correct":false,"justification":"They most often differ from one tissue to another"},{"idx":3,"proposition":"About 30% of cancers are linked to a genetic predisposition syndrome","correct":false,"justification":"The estimate is around 10%"},{"idx":4,"proposition":"The constitution strictly regulates oncogenetic tests","correct":false,"justification":"The supervision of oncogenetic tests is highly regulated by the Bioethics Act (but not by the constitution)"}],"type":"custom"}
{"_id":"DgKc-onco-0","context":null,"enonce":"Which of the following proposals do not require imaging for follow-up?","item":"DgKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Melanoma","correct":false},{"idx":1,"proposition":"The ovary","correct":true,"justification":"Surveillance is clinical (+\/biomarkers such as Ca 125)"},{"idx":2,"proposition":"The endometrium","correct":true,"justification":"Surveillance is clinical"},{"idx":3,"proposition":"The lung","correct":false},{"idx":4,"proposition":"The kidney","correct":false}],"type":"custom"}
{"_id":"anaphylaxie-urg-1","context":null,"enonce":"At what dosage should IM adrenaline be introduced?","item":"anaphylaxie","matiere":"urg","propositions":[{"idx":0,"proposition":"0.01 mg\/kg, up to 0.5 mg","correct":true},{"idx":1,"proposition":"0.05 mg\/kg, up to 0.5 mg","correct":false,"justification":"False"},{"idx":2,"proposition":"0.01 mg\/kg, up to 0.1 mg","correct":false,"justification":"False"},{"idx":3,"proposition":"0.1 mg\/kg, up to 0.5 mg","correct":false,"justification":"False"},{"idx":4,"proposition":"0.05 mg\/kg, up to 0.1 mg","correct":false,"justification":"False"}],"type":"custom"}
{"_id":"anaphylaxie-urg-5","context":null,"enonce":"What is a grade III severity according to the Ring and Messmer classification?","item":"anaphylaxie","matiere":"urg","propositions":[{"idx":0,"proposition":"Generalized mucocutaneous signs","correct":false,"justification":"Grade I"},{"idx":1,"proposition":"Moderate multi-organ involvement","correct":false,"justification":"Grade II"},{"idx":2,"proposition":"Severe life-threatening multi-organ disease","correct":true,"justification":"True, collapse, tachycardia or bradycardia, heart rhythm disturbances, bronchospasm"},{"idx":3,"proposition":"Cardiocirculatory inefficiency and respiratory arrest","correct":false,"justification":"Grade IV"},{"idx":4,"proposition":"None of the proposals","correct":false,"justification":"False"}],"type":"custom"}
{"_id":"obesite-endoc-1","context":null,"enonce":"What is the prevalence of obesity in France?","item":"obesite","matiere":"endoc","propositions":[{"idx":0,"proposition":"0.17","correct":true},{"idx":1,"proposition":"0.22","correct":false},{"idx":2,"proposition":"0.27","correct":false},{"idx":3,"proposition":"0.32","correct":false},{"idx":4,"proposition":"0.37","correct":false}],"type":"custom"}
{"_id":"myasthenie-neuro-2","context":null,"enonce":"Regarding the diagnosis of myasthenia gravis:","item":"myasthenie","matiere":"neuro","propositions":[{"idx":0,"proposition":"Evolution is chronic and unpredictable","correct":true},{"idx":1,"proposition":"Severe crises require hospitalization in intensive care","correct":true},{"idx":2,"proposition":"Myasthenia gravis is not impacted by pregnancy","correct":false,"justification":"Possible worsening of myasthenia gravis during the first 3 months of pregnancy and postpartum"},{"idx":3,"proposition":"Anti-RAC is present in 15% of patients, so their sensitivity is low","correct":false,"justification":"Anti-acetylcholine receptor (anti-RAC) antibodies are present in 80% of patients with generalized myasthenia gravis and in 50% of those with ocular myasthenia gravis"},{"idx":4,"proposition":"Anti-MuSK antibodies are present in 75% of cases of generalized myasthenia gravis","correct":false,"justification":"15 %"}],"type":"custom"}
{"_id":"diabete-endoc-11","context":null,"enonce":"Which of the following proposals are essential for the annual check-up of a diabetic patient?","item":"diabete","matiere":"endoc","propositions":[{"idx":0,"proposition":"HbA1c","correct":true,"justification":"True, performed every three months"},{"idx":1,"proposition":"Urine strip","correct":true,"justification":"True, every year"},{"idx":2,"proposition":"Fundus","correct":true,"justification":"True, every year"},{"idx":3,"proposition":"Foot examination","correct":true},{"idx":4,"proposition":"Insulinemia","correct":false,"justification":"False"}],"type":"custom"}
{"_id":"TS-urg-9","context":null,"enonce":"Which of the following are protective factors lowering the level of risk?","item":"TS","matiere":"urg","propositions":[{"idx":0,"proposition":"Children and close circle","correct":true},{"idx":1,"proposition":"religion ","correct":true},{"idx":2,"proposition":"impulsive personality","correct":false,"justification":"Risk factor"},{"idx":3,"proposition":"handicap ","correct":false,"justification":"Risk factor"},{"idx":4,"proposition":"Farewell letter","correct":false,"justification":"This is a measure taken, so testifying to a scenario, so it fits into the emergency (rUd) and not the risk (Rud)"}],"type":"custom"}
{"_id":"AES-infectio-5","context":null,"enonce":"The HBV seroconversion rate following AES in an unvaccinated or non-responding person is:","item":"AES","matiere":"infectio","propositions":[{"idx":0,"proposition":"Close to 0%","correct":false,"justification":"This is 0% if the person is vaccinated and has an HBsAg level > 10 IU."},{"idx":1,"proposition":"0,3%","correct":false,"justification":"0,3%"},{"idx":2,"proposition":"3%","correct":false,"justification":"3%"},{"idx":3,"proposition":"40%","correct":true,"justification":"None"},{"idx":4,"proposition":"50%","correct":false,"justification":"50% in the case of sexual intercourse with an HBV+ person"}],"type":"custom"}
{"_id":"parasitedig-infectio-2","context":null,"enonce":"Which of the following propositions are true about taeniosis?","item":"parasitedig","matiere":"infectio","propositions":[{"idx":0,"proposition":"Cysticercosis is rare but serious","correct":true,"justification":"True, especially if brain cysts are present"},{"idx":1,"proposition":"Hypereosinophilia","correct":true,"justification":"True, it is the main biological ☣ sign"},{"idx":2,"proposition":"Treatment is based on Praziquantel PO","correct":true,"justification":"True, preceded by corticosteroid therapy"},{"idx":3,"proposition":"The worms concerned are platyhelminths","correct":true,"justification":"True, they are T. Saginata and T. Solium"},{"idx":4,"proposition":"The worms concerned are cestodes","correct":true}],"type":"custom"}
{"_id":"suivivalv-infectio-4","context":null,"enonce":"Concerning the monitoring of vascular prosthesis wearers","item":"suivivalv","matiere":"infectio","propositions":[{"idx":0,"proposition":"There is a high thromboembolic risk if the patient wears a ball or single-disc prosthesis.","correct":true},{"idx":1,"proposition":"The patient's thromboembolic risk factors include: atrial fibrillation, LVEF > 50%, thromboembolic history","correct":false,"justification":"AF, LVEF < 35%, thromboembolic history, mitral or tricuspid prosthesis, associated mitral stenosis, hypercoagulability (only in the USA)"},{"idx":2,"proposition":"TAVI stands for Trans Aortic Valve Implantation","correct":true},{"idx":3,"proposition":"In post-op, INR is checked 1 to 2 times a week until equilibrium and then 1 time per month.","correct":true,"justification":"The patient notes his INR in a VKA monitoring log"},{"idx":4,"proposition":"Antibiotic prophylaxis for risky procedures (dental ablation or scaling) is performed with Clindamycin as a first-line treatment.","correct":false,"justification":"Amoxicillin 2g"}],"type":"custom"}
{"_id":"opacitetho-pneumo-3","context":null,"enonce":"Which of the following are true?","item":"opacitetho","matiere":"pneumo","propositions":[{"idx":0,"proposition":"To date, there is no official French recommendation for \"mass\" screening for bronchial cancer.","correct":true},{"idx":1,"proposition":"False negatives on PET-CT are possible when the size of the nodule is less than 1 cm","correct":true,"justification":"This is the resolution limit of current machines"},{"idx":2,"proposition":"CT does not expose to false positives","correct":false,"justification":"CT exposes to false positives are encountered in connection with inflammatory and granulomatous processes"},{"idx":3,"proposition":"Irregular contours are criteria for benignity ","correct":false,"justification":"Irregular contours are criteria for malignancy"},{"idx":4,"proposition":"Benign tumors and attenuated malignancy tumors account for 1\/10th of thoracic nodules  ","correct":true,"justification":"They are in the form of a single, spherical and regular contour opacity."}],"type":"custom"}
{"_id":"IVG-gyn-0","context":null,"enonce":"Regarding the epidemiology and history of abortion:","item":"IVG","matiere":"gyn","propositions":[{"idx":0,"proposition":"The number of abortions performed in France is constantly increasing","correct":false,"justification":"The number has been virtually stable since 2006"},{"idx":1,"proposition":"Every year, 14.7 abortions per 1,000 women aged 15 to 49 are performed in France","correct":true},{"idx":2,"proposition":"The 1953 decree authorizes therapeutic abortion if the mother's life is seriously threatened","correct":true},{"idx":3,"proposition":"The Veil law was passed on 28 June 2004","correct":false,"justification":"It was on 28 June 1974 that the national representation voted the bill of Simone Veil, then Minister of Health, on the liberalisation of contraception."},{"idx":4,"proposition":"Social Security reimburses the pill from 1974","correct":true}],"type":"custom"}
{"_id":"IVG-gyn-7","context":null,"enonce":"Concerning abortion consultations","item":"IVG","matiere":"gyn","propositions":[{"idx":0,"proposition":"In case of medical abortion and negative Rhesus, anti-D IGG is injected in IV on the day of taking mifepristone","correct":true},{"idx":1,"proposition":"Contraception must be prescribed for the day after the abortion","correct":true},{"idx":2,"proposition":"The insertion of an IUD is possible intraoperatively in case of surgical abortion","correct":true},{"idx":3,"proposition":"Post-abortion consultation is mandatory","correct":false,"justification":"Post-abortion consultation is recommended but not mandatory"},{"idx":4,"proposition":"The fourth consultation is mandatory","correct":true,"justification":"TRUE. There is a discrepancy with the fourth edition of the College of Gynecology. Indeed, in the latter, Table 8.1 page 79 says the capital D explain that post-IVg consultation is advisable but not mandatory. However, the HAS sheet on abortion (which you can find here: https:\/\/www.has-sante.fr\/upload\/docs\/application\/pdf\/2018-06\/cteval351_fiche_bum_ivg_medicamenteuse.pdf) explains that, from now on, <<A follow-up visit is mandatory within 14 to 21 days for both surgical abortion and medical abortion>>."}],"type":"custom"}
{"_id":"epidemio-sp-2","context":null,"enonce":"Concerning the different types of epidemiological studies","item":"epidemio","matiere":"sp","propositions":[{"idx":0,"proposition":"Events occurred before the start of the study in prospective surveys","correct":false,"justification":"Prospective studies: at the beginning of the investigation, events (e.g. disease onset) have not yet occurred, it is necessary to wait for events to occur to observe data."},{"idx":1,"proposition":"Cohort studies are always retrospective.","correct":false,"justification":"They can be. But the idea is to be as forward-looking as possible."},{"idx":2,"proposition":"The objective of epidemiological investigations must be as clear as possible","correct":true},{"idx":3,"proposition":"Cohort studies can be retrospective or prospective","correct":true},{"idx":4,"proposition":"Cross-sectional studies have no temporality parameter","correct":true,"justification":"TRUE\""}],"type":"custom"}
{"_id":"pathogeria-geria-0","context":null,"enonce":"General generalities:","item":"pathogeria","matiere":"geria","propositions":[{"idx":0,"proposition":"The semiology of the elderly is atypical","correct":true,"justification":"Ex: absence of fever during infection"},{"idx":1,"proposition":"Frailty is an irreversible state due to age","correct":false,"justification":"It is potentially reversible"},{"idx":2,"proposition":"Fecal impaction is a chronic pathology in the elderly","correct":false,"justification":"Acute"},{"idx":3,"proposition":"Identifying polypathology is essential","correct":true},{"idx":4,"proposition":"The elderly may present a borrowed semiology","correct":true}],"type":"custom"}
{"_id":"securisation-sp-0","context":null,"enonce":"Which of the following are true?","item":"securisation","matiere":"sp","propositions":[{"idx":0,"proposition":"A medical team is a group of professionals who are committed to working together around a common patient-centered project.","correct":true},{"idx":1,"proposition":"Teamwork is the meeting of a group whose objective is to jointly carry out a set of specific tasks.","correct":true},{"idx":2,"proposition":"The patient is the recipient of the fruit of teamwork but is never integrated into it","correct":false,"justification":"The patient is at the centre of teamwork and is encouraged to participate in this work. \"Effective\" teams have:"},{"idx":3,"proposition":"A team is formed on the basis of a shared project","correct":true},{"idx":4,"proposition":"The choice of members is based on the search for necessary and complementary skills","correct":true}],"type":"custom"}
{"_id":"recherche-sp-0","context":null,"enonce":"Which of these propositions are true?","item":"recherche","matiere":"sp","propositions":[{"idx":0,"proposition":"The scientific question asked must be relevant and innovative","correct":true},{"idx":1,"proposition":"The scientific question asked must be infeasible, hence the need for research","correct":false,"justification":"Be feasible,"},{"idx":2,"proposition":"The scientific question asked must arouse the interest of the investigators","correct":true},{"idx":3,"proposition":"The scientific question posed must not be original or innovative","correct":false,"justification":"Be original"},{"idx":4,"proposition":"The scientific question posed must be ethical.","correct":true,"justification":"TRUE\""}],"type":"custom"}
{"_id":"recherche-sp-6","context":null,"enonce":"Concerning the literature search of Methodology in clinical research","item":"recherche","matiere":"sp","propositions":[{"idx":0,"proposition":"Analytical databases are accessible via the Internet and provide systematic reviews","correct":true},{"idx":1,"proposition":"The Cochrane library is an electronic database initiated in 2018 in Switzerland","correct":false,"justification":"The Cochrane library: Electronic database Initiated in 1995 in Great Britain It provides regularly updated systematic reviews of the literature Major source of information for practitioners Medical bibliographic databases"},{"idx":2,"proposition":"MEDLINE, created in 1966 in the USA, is the best known and most widely used database","correct":true},{"idx":3,"proposition":"EMSABE is a database founded in Russia during the Cold War","correct":false,"justification":"EMBASE, the Netherlands"},{"idx":4,"proposition":"Pubmed is the search engine for accessing MEDLINE data","correct":true,"justification":"TRUE\""}],"type":"custom"}
{"_id":"recherche-sp-8","context":null,"enonce":"Regarding the different types of clinical studies:","item":"recherche","matiere":"sp","propositions":[{"idx":0,"proposition":"Non-interventional research consists of introducing only placebos for patients randomized to the Control group","correct":false,"justification":"All acts and products are used in the usual way, without additional procedure"},{"idx":1,"proposition":"Patient cohort research may be non-interventional","correct":true,"justification":"Observational research, for example,"},{"idx":2,"proposition":"Research on samples is most often non-interventional","correct":true,"justification":"As long as it doesn't change anything for patients"},{"idx":3,"proposition":"Non-interventional research does not require patient consent","correct":false,"justification":"Consent is always required."},{"idx":4,"proposition":"Research on medical data is most often non-interventional and makes it possible to dispense with patient consent","correct":false,"justification":"Consent is a necessity for all types of research.\""}],"type":"custom"}
{"_id":"recherche-sp-11","context":null,"enonce":"Which of these propositions are true?","item":"recherche","matiere":"sp","propositions":[{"idx":0,"proposition":"In pharmacology, clinical research is dominated by studies of the drug, as part of clinical trials.","correct":true},{"idx":1,"proposition":"Clinical trials follow a technique (clinical trial methodology), legislation and ethics","correct":true},{"idx":2,"proposition":"These studies take place exclusively in hospitals and research laboratories.","correct":false,"justification":"These studies can either in town medicine, or in hospitals, or legislation and one (cf. item 8). ethics take place research in public or private approved structures. The different phases of drug development 1.Exploratory research of a molecule:"},{"idx":3,"proposition":"The filing of the patent by the industrialist has a duration of 35 years","correct":false,"justification":"Filing of a patent by the industrialist, candidate who assures him exploitation rights for a period of 20 years"},{"idx":4,"proposition":"The establishment of a research program is usually subsequent to the filing of a patent","correct":true,"justification":"TRUE\""}],"type":"custom"}
{"_id":"autoformation-sp-5","context":null,"enonce":"Regarding Clinical Practice Recommendations (CPR)","item":"autoformation","matiere":"sp","propositions":[{"idx":0,"proposition":"The promoter is usually the HAS","correct":true},{"idx":1,"proposition":"The task of the working group is to bring together international experts to discuss the subject.","correct":false,"justification":"Mission: write the recommendations after reading the bibliographic data"},{"idx":2,"proposition":"The working group is composed of 3 researchers and 3 doctors","correct":false,"justification":"It is composed of 15 to 20 professionals and representatives of patients or users, with good professional knowledge."},{"idx":3,"proposition":"The reading group is composed of 30 to 50 people concerned by the theme treated, expert or not","correct":true},{"idx":4,"proposition":"All members of the reading group must come from a single discipline: the one most concerned by the question","correct":false,"justification":"It is multidisciplinary, professional and representative of the diversity of the more than 3.3.3. Method 1. Phase of systematic review and synthesis of the literature\""}],"type":"custom"}
{"_id":"MAI-immuno-2","context":null,"enonce":"Regarding autoimmune diseases:","item":"MAI","matiere":"immuno","propositions":[{"idx":0,"proposition":"Rarely, autoimmune diseases are called \"monogenic diseases\", when the occurrence of a mutation of a single gene is enough to confer a very marked increase in the risk of developing the disease.","correct":true,"justification":"It is indeed very rare"},{"idx":1,"proposition":"The weight of genetics is greater in forms of revelation in adulthood","correct":false,"justification":"The weight of genetics is greater in forms with pediatric revelation"},{"idx":2,"proposition":"Many environmental factors could play a role in the occurrence of autoimmune diseases","correct":true},{"idx":3,"proposition":"In practice, the diagnosis of autoimmune disease is based on the association of suggestive clinical and \/ or biological manifestations and evidence of autoimmunity (or biological stigmas thereof)","correct":true},{"idx":4,"proposition":"The presence of autoantibodies indicates the existence of an autoimmune disease","correct":false,"justification":"The presence of autoantibodies does not necessarily indicate the existence of an autoimmune disease, since any stimulation of the immune system (for example during certain infections) can lead to the formation of autoantibodies"}],"type":"custom"}
{"_id":"MAI-immuno-10","context":null,"enonce":"Which of the following proposals are suspect of a Gougerot-Sjögren?","item":"MAI","matiere":"immuno","propositions":[{"idx":0,"proposition":"Dry mouth","correct":true},{"idx":1,"proposition":"Xerophthalmia","correct":true},{"idx":2,"proposition":"Dry syndrome","correct":true},{"idx":3,"proposition":"Polyuropolydipsia","correct":false,"justification":"Not described in the GS"},{"idx":4,"proposition":"Rhizemelic arthritis","correct":false,"justification":"Possible association with rheumatoid arthritis"}],"type":"custom"}
{"_id":"noduleTh-endoc-0","context":null,"enonce":"Regarding goiters:","item":"noduleTh","matiere":"endoc","propositions":[{"idx":0,"proposition":"A thyroid volume of 18 mL is normal in an adult male","correct":true,"justification":"The ultrasound criteria for a goiter are a thyroid volume > 16 ml in adolescents, > 18 ml in women and > 20 ml in men."},{"idx":1,"proposition":"A goiter signs hyperthyroidism","correct":false,"justification":"The existence of a goiter does not prejudge thyroid function."},{"idx":2,"proposition":"Thyroid goiters affect more than 70% of the population","correct":false,"justification":"It is a pathology encountered in more than 10% of the population"},{"idx":3,"proposition":"Prevalence increases with age","correct":true},{"idx":4,"proposition":"The sex ratio is 3 women to 1 man","correct":true}],"type":"custom"}
{"_id":"veilleSP-sp-1","context":null,"enonce":"Which health security agencies have a direct role in health surveillance?","item":"veilleSP","matiere":"sp","propositions":[{"idx":0,"proposition":"The ANSM","correct":true},{"idx":1,"proposition":"The HAS","correct":false,"justification":"Not directly"},{"idx":2,"proposition":"The Academy of Medicine","correct":false,"justification":"Not directly"},{"idx":3,"proposition":"WAXES","correct":true,"justification":"Regional intervention units"},{"idx":4,"proposition":"The ARS","correct":true}],"type":"custom"}
{"_id":"zoonose-infectio-5","context":null,"enonce":"Which of the following are true about leishmaniasis?","item":"zoonose","matiere":"infectio","propositions":[{"idx":0,"proposition":"It is a directly transmitted disease","correct":false,"justification":"It requires a vector (the sandfly)"},{"idx":1,"proposition":"It is a parasitic disease","correct":true},{"idx":2,"proposition":"It is due to plathelmint","correct":false,"justification":"The parasite is a flagellate protozoan"},{"idx":3,"proposition":"The involvement can be cutaneous or visceral","correct":true},{"idx":4,"proposition":"Fever is high and constant 🤒 ","correct":false,"justification":"The fever is oscillating"}],"type":"custom"}
{"_id":"immunoD-immuno-0","context":null,"enonce":"Which of the following are true?","item":"immunoD","matiere":"immuno","propositions":[{"idx":0,"proposition":"Immune deficiencies are hereditary","correct":false,"justification":"They can also be acquired"},{"idx":1,"proposition":"The prevalence of immunodeficiencies is about 2000 cases in France","correct":true},{"idx":2,"proposition":"More than 700,000 causative genes have been identified","correct":false,"justification":"About 300 genes"},{"idx":3,"proposition":"Iron deficiency may be a secondary cause of immune deficiency","correct":false,"justification":"Anemia. Zinc deficiency causes immune deficiency."},{"idx":4,"proposition":"Selective IgA deficiency is often asymptomatic","correct":true,"justification":"True, this is the most common deficit"}],"type":"custom"}
{"_id":"tbiono-nephro-7","context":null,"enonce":"pH: 7.41. pO2: 68 mmHg. pCO2: 52 mmHg. Bicarbonates: 31 mmol\/L. ","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"proposition":"Hypoxia","correct":true,"justification":"True, because pO2 < 75 mmHg"},{"idx":1,"proposition":"Hypocapnia","correct":false,"justification":"Hypercapnia"},{"idx":2,"proposition":"Hypercapnia","correct":true,"justification":"True, because pCO2 > 45 mmHg"},{"idx":3,"proposition":"Compensated respiratory acidosis","correct":true,"justification":"True, offset by the increase in Bicarbonates"},{"idx":4,"proposition":"Compensated respiratory alkalosis","correct":false,"justification":"It is potentially a compensated METABOLIC alkalosis but not respiratory :)"}],"type":"custom"}
{"_id":"tbiono-nephro-11","context":null,"enonce":"Which of the following may be ECG abnormalities secondary to hypokalemia?","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"proposition":"PR at 189 ms ","correct":false,"justification":"PR < 0.2s normal (between 0.12 and 0.20)"},{"idx":1,"proposition":"QRS at 85 ms","correct":false,"justification":"QRS < 0.1s normal (between 100 and 120 ms: incomplete branch block. Beyond 120 ms: branch block)"},{"idx":2,"proposition":"QT at 490ms","correct":true,"justification":"True, QT prolongation is an abnormality of hypokalemia"},{"idx":3,"proposition":"U-wave","correct":true},{"idx":4,"proposition":"ST segment depression","correct":true}],"type":"custom"}
{"_id":"valvuloP-cardio-4","context":null,"enonce":"Regarding aortic stricture","item":"valvuloP","matiere":"cardio","propositions":[{"idx":0,"proposition":"The orificial area of a normal aortic valve is 2 to 3.5 cm2","correct":true},{"idx":1,"proposition":"In case of aortic narrowing, the valve surface increases sharply","correct":false,"justification":"This surface decreases: the valve opens less well."},{"idx":2,"proposition":"We speak of tight aortic narrowing for an area < 1 cm2 or < 0.60 cm2\/m2 of body surface area","correct":true},{"idx":3,"proposition":"The criteria for tight AR are a Vmax > 4 m\/sec; an average gradient > 40 mmHg; an aortic surface < 1 cm2 or < 0.6 cm2\/m2","correct":true},{"idx":4,"proposition":"In AR, ETT can also rule out another valve involvement and measure the size of the aorta","correct":true,"justification":"RA is often accompanied by an aneurysm of the ascending aorta"}],"type":"custom"}
{"_id":"valvuloP-cardio-8","context":null,"enonce":"Regarding mitral insufficiency","item":"valvuloP","matiere":"cardio","propositions":[{"idx":0,"proposition":"Carpentier type II is characterized by elongations or breaks of ropes responsible for valacular prolapse","correct":true},{"idx":1,"proposition":"Functional mitral insufficiency is frequently encountered at an advanced stage of heart disease, in case of dilation of the LV","correct":true,"justification":"because of the dilation of the valve ring (Type I according to the Carpentier classification)"},{"idx":2,"proposition":"Acute mitral regurgitation may ultimately be responsible for a serious hemodynamic picture justifying emergency management","correct":true},{"idx":3,"proposition":"The regurgitated volume depends on three main factors: the size of the regurgitating orifice; the pressure gradient; the duration of systole","correct":true},{"idx":4,"proposition":"Functional signs of MI are headache, exertional dyspnea and stress syncope.","correct":false,"justification":"Main functional signs of symptomatic MI: palpitations, exertional dyspnoea or exertional asthenia"}],"type":"custom"}
{"_id":"lithiaseB-HGE-1","context":null,"enonce":"About cholelithiasis and its complications","item":"lithiaseB","matiere":"HGE","propositions":[{"idx":0,"proposition":"There are 3 types of gallstones: cholesterolic (80%), pigmentary (20%), mixed","correct":true},{"idx":1,"proposition":"female sex; overweight (and significant changes in weight); multiparity; Prolonged fasting are risk factors for cholesterolic gallstones","correct":true},{"idx":2,"proposition":"100% of patients in total parenteral nutrition have vesicular lithiasis after one month","correct":true},{"idx":3,"proposition":"Pigmentosa lithiasis is due to deconjugation of bilirubin which is soluble in deconjugated form and insoluble in conjugated form","correct":false,"justification":"Pigmentosa lithiasis is due to a deconjugation of bilirubin which is soluble in conjugated form and insoluble in deconjugated form"},{"idx":4,"proposition":"Risk factors for urolithiasis pigmentosa include certain geographical origins, biliary infections, biliary obstructions","correct":true}],"type":"custom"}
{"_id":"dvlptpsychoMo-psy-2","context":null,"enonce":"Regarding child development and intelligence:","item":"dvlptpsychoMo","matiere":"psy","propositions":[{"idx":0,"proposition":"Neurodevelopmental disorders have a multifactorial origin","correct":true},{"idx":1,"proposition":"Management of patients with neurodevelopmental disorders should be multidisciplinary","correct":true},{"idx":2,"proposition":"Intelligence is the ability to solve complex mathematical problems","correct":false,"justification":"According to the College of Psychiatry, intelligence is a set of abilities that allow an individual to adapt to his environment. Solving mathematical problems therefore does not define intelligence"},{"idx":3,"proposition":"Age-standardized tests estimate ITQ – Total IQ","correct":true,"justification":"IQ measures ability, but not intelligence. The ITQ can only be calculated if the scores on the different subscales are homogeneous."},{"idx":4,"proposition":"ITQ scores average 120 with a standard deviation of 35 in the general population","correct":false,"justification":"ITQ scores average 100 with a standard deviation of 15 in the general population"}],"type":"custom"}
{"_id":"NFS-hemato-6","context":null,"enonce":"Which of the following are the causes of secondary polycythemia?","item":"NFS","matiere":"hemato","propositions":[{"idx":0,"proposition":"Stenosis of the renal artery","correct":true,"justification":"True, other cardiovascular (hypertension) and renal signs"},{"idx":1,"proposition":"COPD","correct":true,"justification":"True, the context is evocative"},{"idx":2,"proposition":"Stay at altitude in acute","correct":true,"justification":"True, by rarefaction of the air"},{"idx":3,"proposition":"EPO-secreting renal tumour","correct":true},{"idx":4,"proposition":"2,3-DPG deficiency","correct":true,"justification":"True, it is a very rare deficit. Present in red blood cells, 2-3 DPG promotes the dissociation of oxyhemoglobin in tissues. This 2-3 DPG deficiency may therefore be responsible for tissue hypoxia with its own consequences."}],"type":"custom"}
{"_id":"BPCO-pneumo-6","context":null,"enonce":"About COPD","item":"BPCO","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Cardiac evaluation is recommended in case of signs suggestive of cardiac disease or cardiovascular comorbidity","correct":true},{"idx":1,"proposition":"CBC looks for polycythemia reactive to hypoxemia, anemia that may worsen dyspnea","correct":true},{"idx":2,"proposition":"The alpha-1 antitrypsin assay is indicated in case of § Early COPD (< 45 years)","correct":true},{"idx":3,"proposition":"t pharmacological management of COPD must be accompanied in particular Smoking cessation aid • Vaccinations • Physical activity advice • Dietary advice are an integral part of the treatment","correct":true},{"idx":4,"proposition":"Smoking cessation is the main measure that can interrupt the progression of bronchial obstruction and delay the onset of respiratory failure","correct":true}],"type":"custom"}
{"_id":"sexualite-psy-4","context":null,"enonce":"Regarding sexual desire disorders:","item":"sexualite","matiere":"psy","propositions":[{"idx":0,"proposition":"It is a decrease or absence of sexual desire and interest","correct":true},{"idx":1,"proposition":"It is extremely rare to be averse to all or part of sexual activities","correct":false,"justification":"We can often observe an aversion to all or part of sexual activities"},{"idx":2,"proposition":"We must think about systematically eliminating a non-psychiatric differential diagnosis of hypogonadism","correct":true},{"idx":3,"proposition":"The assessment of the impairment is done by the psychologist","correct":false,"justification":"The assessment of impairment is made by the clinician who must take into account factors that may affect sexual functioning such as age and general and sociocultural contexts of the subject's life."},{"idx":4,"proposition":"Erectile dysfunction affects 30% of men over 50","correct":true}],"type":"custom"}
{"_id":"sexualite-psy-11","context":null,"enonce":"What is the neurotransmitter that increases arousal and desire?","item":"sexualite","matiere":"psy","propositions":[{"idx":0,"proposition":"Serotonin","correct":false,"justification":"Researchers believe that serotonin curbs arousal and desire"},{"idx":1,"proposition":"Dopamine","correct":true,"justification":"Dopamine increases arousal and desire"},{"idx":2,"proposition":"Le GABA","correct":false,"justification":"College does not report GABA role in sexuality"},{"idx":3,"proposition":"Glutamate","correct":false},{"idx":4,"proposition":"Endorphins","correct":false,"justification":"Endorphins are involved in the refractory phase mainly"}],"type":"custom"}
{"_id":"nutrigrossesse-endoc-0","context":null,"enonce":"Regarding insulin resistance during pregnancy, which proposals are true?","item":"nutrigrossesse","matiere":"endoc","propositions":[{"idx":0,"proposition":"It allows the fetus to have more glucose","correct":true},{"idx":1,"proposition":"It concerns the liver","correct":true},{"idx":2,"proposition":"It concerns the brain","correct":false,"justification":"The two main organs affected by this increase in insulin resistance are the muscles and the liver."},{"idx":3,"proposition":"It is favored by estrogens","correct":false,"justification":"It is promoted by progesterone and HLP"},{"idx":4,"proposition":"It can cause type 1 diabetes","correct":false}],"type":"custom"}
{"_id":"nutrigrossesse-endoc-2","context":null,"enonce":"Regarding vitamin supplementation, which proposals are true?","item":"nutrigrossesse","matiere":"endoc","propositions":[{"idx":0,"proposition":"Vitamin B9 supplementation is recommended pre-conception","correct":true},{"idx":1,"proposition":"Vitamin A supplementation is recommended from the third trimester","correct":false,"justification":"It is contraindicated because it is teratogenic"},{"idx":2,"proposition":"Vitamin D supplementation is contraindicated in pregnant women","correct":false,"justification":"It is systematic in the third trimester"},{"idx":3,"proposition":"All meats are rich in folic acid","correct":false,"justification":"Especially the liver"},{"idx":4,"proposition":"Vitamin K supplementation is indicated in pregnant women with anti-tuberculosis drugs","correct":true}],"type":"custom"}
{"_id":"nutrigrossesse-endoc-3","context":null,"enonce":"For diabetic women who want to become pregnant:","item":"nutrigrossesse","matiere":"endoc","propositions":[{"idx":0,"proposition":"This is a high-risk pregnancy","correct":true},{"idx":1,"proposition":"The HbA1c target is less than or equal to 6.5%","correct":true,"justification":""},{"idx":2,"proposition":"There is a significant risk of miscarriage in the 3rd trimester","correct":false,"justification":"The risk of miscarriage is especially present in the first trimester. In the third trimester, there is a risk of prematurity or the need for caesarean section"},{"idx":3,"proposition":"There is a risk of fetal tissue hypoxia in the 2nd trimester","correct":true},{"idx":4,"proposition":"There is an increased risk of retinopathy for the mother during pregnancy","correct":true}],"type":"custom"}
{"_id":"nutrigrossesse-endoc-5","context":null,"enonce":"Which of the following are not associated with an increased risk of gestational diabetes (GDM)?","item":"nutrigrossesse","matiere":"endoc","propositions":[{"idx":0,"proposition":"Age greater than or equal to 35 years","correct":false,"justification":"It is a risk factor of DG"},{"idx":1,"proposition":"Low socio-economic level","correct":true,"justification":"True, no demonstrated link with DG"},{"idx":2,"proposition":"Polycystic ovary syndrome","correct":false,"justification":"It is a risk factor of DG"},{"idx":3,"proposition":"Multiparity","correct":true},{"idx":4,"proposition":"Smoking","correct":true}],"type":"custom"}
{"_id":"nutrigrossesse-endoc-6","context":null,"enonce":"Complete this sentence: Macrosomia is defined for a birth weight beyond ..... th percentile.","item":"nutrigrossesse","matiere":"endoc","propositions":[{"idx":0,"proposition":"60","correct":false,"justification":"90"},{"idx":1,"proposition":"70","correct":false,"justification":"90"},{"idx":2,"proposition":"80","correct":false,"justification":"90"},{"idx":3,"proposition":"90","correct":true},{"idx":4,"proposition":"95","correct":false,"justification":"90"}],"type":"custom"}
{"_id":"KcSNC-onco-7","context":null,"enonce":"Which of the following proposals about meningiomas are true?","item":"KcSNC","matiere":"onco","propositions":[{"idx":0,"proposition":"Meningioma has a high potential for malignancy","correct":false,"justification":"Meningioma is benign"},{"idx":1,"proposition":"Meningioma develops in the subdural space from arachnoid cells","correct":true},{"idx":2,"proposition":"Meningioma is part of neurofibromatosis type 2","correct":true,"justification":"True, neurological, ocular and cutaneous involvement. The diagnosis is made according to the Manchester criteria"},{"idx":3,"proposition":"Meningioma is often asymptomatic","correct":true},{"idx":4,"proposition":"All propositions are true","correct":false,"justification":"False"}],"type":"custom"}
{"_id":"KcSNC-onco-18","context":null,"enonce":"Prognostic factors for gliomas: ","item":"KcSNC","matiere":"onco","propositions":[{"idx":0,"proposition":"Age","correct":true,"justification":"Age"},{"idx":1,"proposition":"Sex ","correct":false,"justification":"False"},{"idx":2,"proposition":"The grade of glioma ","correct":true,"justification":"The grade of glioma"},{"idx":3,"proposition":"The presence of liver metastases","correct":false,"justification":"False: gliomas very rarely metastasize at the systemic level"},{"idx":4,"proposition":"The 1p19q deletion","correct":true,"justification":"Favourable prognosis"}],"type":"custom"}
{"_id":"jamberouge-urg-1","context":null,"enonce":"Which of these proposals are risk factors for eristele?","item":"jamberouge","matiere":"urg","propositions":[{"idx":0,"proposition":"A BMI of 35","correct":true,"justification":"Obesity is a risk factor"},{"idx":1,"proposition":"Edema of the lower limbs","correct":true},{"idx":2,"proposition":"Chronic asthenia","correct":false},{"idx":3,"proposition":"Taking spironolactone","correct":false,"justification":"Spironolactone is an anti-aldosterone (in the renal collecting tube) and therefore acts as a potassium-sparing hard. It is not considered a risk factor for erisipelas"},{"idx":4,"proposition":"A viral gateway","correct":false,"justification":"Erysipelas is a bacterial dermohypodermatitis"}],"type":"custom"}
{"_id":"hemorroides-HGE-0","context":null,"enonce":"Regarding hemorrhoidal disease","item":"hemorroides","matiere":"HGE","propositions":[{"idx":0,"proposition":"Hemorrhoids are anatomical structures normally present in the healthy individual","correct":true},{"idx":1,"proposition":"Hemorrhoidal disease is the most frequently encountered condition in proctology","correct":true},{"idx":2,"proposition":"There is parallelism between the importance of hemorrhoidal anatomical disease and the symptoms","correct":false,"justification":"There is no parallelism between the importance of hemorrhoidal anatomical disease and the symptoms"},{"idx":3,"proposition":"1\/3 of adults report having suffered at least once from a hemorrhoidal problem","correct":true},{"idx":4,"proposition":"Pregnancy is a risk factor for hemorrhoids","correct":true}],"type":"custom"}
{"_id":"cephalee-neuro-0","context":null,"enonce":"Regarding headaches and neuralgia:","item":"cephalee","matiere":"neuro","propositions":[{"idx":0,"proposition":"Headache is an objective symptom that motivates frequent consultations","correct":false,"justification":"Headache is a subjective symptom"},{"idx":1,"proposition":"Primary headaches are the most common","correct":true},{"idx":2,"proposition":"Secondary headaches are symptomatic of a local (neurological, ENT, ophthalmological) or general cause","correct":true},{"idx":3,"proposition":"Cranial neuralgia, headaches type of electric shocks in the territory of a sensitive nerve, are all essential and without found cause","correct":false,"justification":"They are also divided into essential neuralgia and secondary neuralgia."},{"idx":4,"proposition":"The unusual or habitual nature of the pain is absolutely essential to determine","correct":true}],"type":"custom"}
{"_id":"handicappsy-neuro-2","context":null,"enonce":"Regarding attention and memory","item":"handicappsy","matiere":"neuro","propositions":[{"idx":0,"proposition":"Attention allows the selection and maintenance of information in the field of consciousness","correct":true},{"idx":1,"proposition":"Short-term memory is also called working memory","correct":true},{"idx":2,"proposition":"Long-term memory is divided into procedural memory and declarative memory","correct":true},{"idx":3,"proposition":"Procedural memory engages unconscious processes","correct":true},{"idx":4,"proposition":"Procedural memory is evaluated by MMS","correct":false,"justification":"In routine clinical practice, it is not assessed"}],"type":"custom"}
{"_id":"handicappsy-neuro-6","context":null,"enonce":"Regarding protective measures:","item":"handicappsy","matiere":"neuro","propositions":[{"idx":0,"proposition":"The rescue of justice lasts 5 years","correct":false,"justification":"It lasts 1 year and is renewable once. It is a transitional measure, which can be put in place very quickly. It can be requested by the patient himself, his relatives or his doctors. The representative is appointed by the judge. The patient retains all his civil rights. There are two types of safeguards of justice: medical and judicial."},{"idx":1,"proposition":"Curatorship is established for life","correct":false,"justification":"It is established for 5 years renewable"},{"idx":2,"proposition":"The safeguarding of justice is halfway between curatorship and guardianship","correct":false,"justification":"Curatorship is halfway between safeguarding justice and guardianship"},{"idx":3,"proposition":"Curatorship allows civil rights to be partially preserved","correct":true},{"idx":4,"proposition":"The safeguard of justice is renewable only three times","correct":false,"justification":"Renewable only once"}],"type":"custom"}
{"_id":"LM-onco-3","context":null,"enonce":"Which of the following are symptoms or signs of Hodgkin lymphoma?","item":"LM","matiere":"onco","propositions":[{"idx":0,"proposition":"A cough","correct":true},{"idx":1,"proposition":"A biological inflammatory syndrome","correct":true},{"idx":2,"proposition":"A fever","correct":true},{"idx":3,"proposition":"A tumor lysis syndrome","correct":true},{"idx":4,"proposition":"A macrophage activation syndrome","correct":true}],"type":"custom"}
{"_id":"amenorrhee-gyn-0","context":null,"enonce":"General:","item":"amenorrhee","matiere":"gyn","propositions":[{"idx":0,"proposition":"Amenorrhea is the asbsence of menstruation in a woman of childbearing age","correct":true},{"idx":1,"proposition":"Amenorrhea is physiological in 3 cases: pregnancy, lactation and menopause","correct":true},{"idx":2,"proposition":"Primary amenorrhea and impuberism are synonyms","correct":false,"justification":"Impubertism is the absence of development of secondary sexual characteristics while amenorrhea is the absence of a rule"},{"idx":3,"proposition":"In impuberism, there is no estrogenic secretion","correct":true},{"idx":4,"proposition":"Primary amenorrhea may or may not be accompanied by impuberism","correct":true,"justification":"It can be: • primary: absence of menarche (appearance of the first menstrual period) at 16 years"}],"type":"custom"}
{"_id":"amenorrhee-gyn-6","context":null,"enonce":"Regarding the clinical examination:","item":"amenorrhee","matiere":"gyn","propositions":[{"idx":0,"proposition":"Vaginal examination is offered to all patients to look for a laterouterine mass","correct":false,"justification":"Except virgin patients"},{"idx":1,"proposition":"The TV makes it possible to search for a large uterus","correct":true},{"idx":2,"proposition":"A digital rectal exam is used to check for the existence of a uterus","correct":true},{"idx":3,"proposition":"a digital rectal exam can be used to perceive a hematocolpos if necessary","correct":true,"justification":"It is the retention of menstrual blood in the vagina (for several reasons: hymeneal imperforation, complete vaginal diaphragm, one-eyed hemivagin, etc.)"},{"idx":4,"proposition":"The gynecological examination is completed by the search for galactorrhea","correct":true,"justification":"Senological examination is part of the general examination and gynecological examination"}],"type":"custom"}
{"_id":"SPSC-sp-2","context":null,"enonce":"Within 24 hours of the admission of a patient who is required for psychiatric care:","item":"SPSC","matiere":"sp","propositions":[{"idx":0,"proposition":"A somatic examination must be performed by a doctor","correct":true,"justification":"It must be complete"},{"idx":1,"proposition":"A medical certificate attesting to his mental state must be drawn up","correct":true,"justification":"He must confirm or not the need for continued care"},{"idx":2,"proposition":"The medical certificate must be carried out by the city psychiatrist","correct":false,"justification":"By the psychiatrist of the receiving institution"},{"idx":3,"proposition":"Paramedical examination may cause care to be stopped if staff feel that the patient does not consent","correct":false,"justification":"The decision is up to the doctor"},{"idx":4,"proposition":"The medical certificate of admission can be made by a somatic doctor","correct":false,"justification":"It must be a psychiatrist"}],"type":"custom"}
{"_id":"SPSC-sp-3","context":null,"enonce":"Under what conditions can psychiatric care without consent be stopped?","item":"SPSC","matiere":"sp","propositions":[{"idx":0,"proposition":"On medical certificate","correct":true,"justification":"Anytime"},{"idx":1,"proposition":"By decision of the liberty and detention judge","correct":true},{"idx":2,"proposition":"At the request of the PSDC","correct":true,"justification":"Departmental Commission for Psychiatric Care"},{"idx":3,"proposition":"At the patient's request","correct":false,"justification":"This is the principle of care without consent"},{"idx":4,"proposition":"At the request of a family member","correct":true,"justification":"Unless a psychiatrist at the facility certifies that stopping care would result in a life-threatening risk to the patient"}],"type":"custom"}
{"_id":"grossesseN-gyn-4","context":null,"enonce":"Which of these proposals refer to signs of pregnancy?","item":"grossesseN","matiere":"gyn","propositions":[{"idx":0,"proposition":"A pollakiuria","correct":true},{"idx":1,"proposition":"A rule retad","correct":true},{"idx":2,"proposition":"Bradychardia","correct":false,"justification":"Rather a tachycardia reactive to hemodilution"},{"idx":3,"proposition":"Nausea and vomiting","correct":true},{"idx":4,"proposition":"Breast tension","correct":true}],"type":"custom"}
{"_id":"grossesseN-gyn-11","context":null,"enonce":"Regarding type A, A1 and A2 follow-ups:","item":"grossesseN","matiere":"gyn","propositions":[{"idx":0,"proposition":"Type A follow-up should be performed by a physician","correct":false,"justification":"Regular follow-up can be provided by a midwife or a doctor (general practitioner)"},{"idx":1,"proposition":"A medical gynecologist can follow a type A pregnancy","correct":true},{"idx":2,"proposition":"An obstetrician-gynecologist cannot follow a type A pregnancy","correct":false,"justification":"or gynecologist-obstetrician according to the woman's choice"},{"idx":3,"proposition":"A1 follow-up requires specialist advice","correct":false},{"idx":4,"proposition":"The opinion of an obstetrician gynecologist is necessary in an A2 follow-up","correct":true,"justification":"TRUE\""}],"type":"custom"}
{"_id":"reeducation-mpr-2","context":null,"enonce":"From the following proposals, check the exact answer(s):","item":"reeducation","matiere":"mpr","propositions":[{"idx":0,"proposition":"Physiotherapists are not allowed to prescribe","correct":false,"justification":"A decree published in 2006 (decree 2006-415 of 6 April 2006) authorizes physiotherapists to prescribe a number of medical devices concerning, in particular, the prevention of pressure ulcers and ambulation."},{"idx":1,"proposition":"Deep transverse massage allows the treatment of low back pain","correct":false,"justification":"It is indicated for the treatment of certain tendonitis and lymphatic drainage"},{"idx":2,"proposition":"Joint manipulations are not allowed in the usual therapeutic arsenal","correct":true},{"idx":3,"proposition":"Strengthening proprioceptive sensitivity requires correction of visual acuity if necessary","correct":false,"justification":"It uses joint stress exercises without ocular control"},{"idx":4,"proposition":"Motor, sensory and articular deficiencies of the upper limb are indications for occupational therapy","correct":true}],"type":"custom"}
{"_id":"epilepsie-neuro-0","context":null,"enonce":"The cerebral predisposition to generate repetitive seizures is argued in particular by","item":"epilepsie","matiere":"neuro","propositions":[{"idx":0,"proposition":"The occurrence of at least two click-confirmed unprovoked seizures spaced at least 24 hours apart","correct":true},{"idx":1,"proposition":"A pre-existing neurodevelopmental disorder","correct":true},{"idx":2,"proposition":"The presence of paroxysmal abnormalities on ECG","correct":false,"justification":"It is the EEG that informs us here"},{"idx":3,"proposition":"Pre-existing epileptogen brain injury on imaging","correct":true},{"idx":4,"proposition":"Known migraine attacks","correct":false,"justification":"Not a valid argument"}],"type":"custom"}
{"_id":"epilepsie-neuro-1","context":null,"enonce":"About epilepsy","item":"epilepsie","matiere":"neuro","propositions":[{"idx":0,"proposition":"Epilepsis is a chronic brain disease characterized by a lasting predisposition to generate seizures with clinical and social repercussions","correct":true},{"idx":1,"proposition":"Epilepsy is a heterogeneous group of diseases that can begin from the neonatal period to old age.","correct":true},{"idx":2,"proposition":"Epileptic syndromes are often age-dependent","correct":true},{"idx":3,"proposition":"Seizures are most often predictable","correct":false,"justification":"Epileptic seizures are rarely predictable, clinically very polymorphic, but are often stereotyped for the same patient"},{"idx":4,"proposition":"Epileptic seizures have very different clinical aspects from one patient to another but most often stereotyped in the same patient","correct":true}],"type":"custom"}
{"_id":"epilepsie-neuro-10","context":null,"enonce":"Which of the following are causes of lesional partial epilepsy?","item":"epilepsie","matiere":"neuro","propositions":[{"idx":0,"proposition":"Tumour","correct":true,"justification":"True, supratentorial tumors"},{"idx":1,"proposition":"Head trauma","correct":true},{"idx":2,"proposition":"Infections","correct":true,"justification":"True, meningoencephalitis and parenchymal abscesses for example"},{"idx":3,"proposition":"Cavernoma","correct":true},{"idx":4,"proposition":"Arteriovenous malformation","correct":true}],"type":"custom"}
{"_id":"RGO-HGE-1","context":null,"enonce":"Regarding gastroesophageal reflux disease","item":"RGO","matiere":"HGE","propositions":[{"idx":0,"proposition":"Endobrachyesophagus is defined by the presence of intestinal metaplasia","correct":true},{"idx":1,"proposition":"Endobrachyoesophagus at risk of squamous cell carcinoma of the esophagus and should be monitored","correct":false,"justification":"It exposes to the risk of adenocarcinoma"},{"idx":2,"proposition":"Treatment of GERD relies primarily on proton pump inhibitors","correct":true},{"idx":3,"proposition":"PPIs should be prescribed at full dose during GERD without esophagitis","correct":false,"justification":"Half dose in this case"},{"idx":4,"proposition":"Very noisy symptoms may be present without esophagitis","correct":true}],"type":"custom"}
{"_id":"RGO-HGE-3","context":null,"enonce":"Which of the following proposals support gastroesophageal reflux disease (GERD) in small children?","item":"RGO","matiere":"HGE","propositions":[{"idx":0,"proposition":"Daily regurgitation","correct":false,"justification":"The frequency of regurgitation is not an element of gravity"},{"idx":1,"proposition":"Regurgitation when changing position","correct":false,"justification":"Not an element indicating pathogenicity"},{"idx":2,"proposition":"An unusual pallor","correct":true,"justification":"It signs the hemodynamic impact"},{"idx":3,"proposition":"Laryngeal dyspnea","correct":true,"justification":"Pathological GERD, according to the College of Pediatrics (2021) is defined as GERD accompanied by pathological consequences for the child, such as esophagitis, extradigestive manifestations (ENT, respiratory) or malaise."},{"idx":4,"proposition":"A refusal of the bottle","correct":true,"justification":"May indicate pathological GERD in children, it is a nonspecific sign"}],"type":"custom"}
{"_id":"raisonnement-sp-8","context":null,"enonce":"Decision-making for a given patient should be:","item":"raisonnement","matiere":"sp","propositions":[{"idx":0,"proposition":"Effective","correct":true},{"idx":1,"proposition":"Efficient","correct":true},{"idx":2,"proposition":"Patient consent","correct":true},{"idx":3,"proposition":"Healing","correct":false,"justification":"Curative, Palliative, Non-therapeutic, etc."},{"idx":4,"proposition":"Useful","correct":true}],"type":"custom"}
{"_id":"amylose-hemato-6","context":null,"enonce":"Regarding Fanconi syndrome:","item":"amylose","matiere":"hemato","propositions":[{"idx":0,"proposition":"It is a genetic disease","correct":false,"justification":"Be careful, it should not be confused with Fanconi anemia (which is, indeed, a genetic disease)"},{"idx":1,"proposition":"It affects the distal tubules","correct":false,"justification":"It affects the proximal tubules"},{"idx":2,"proposition":"The most found light chains are kappa type","correct":true},{"idx":3,"proposition":"It may reveal MGUS or underlying myeloma ","correct":true},{"idx":4,"proposition":"It gives a polyuropolydipsic syndrome","correct":true}],"type":"custom"}
{"_id":"soinspsy-psy-3","context":null,"enonce":"Regarding ambulatory and liaison care:","item":"soinspsy","matiere":"psy","propositions":[{"idx":0,"proposition":"Outpatient care refers to all care that does not involve hospitalization","correct":true},{"idx":1,"proposition":"The medical-psychological centers (CMP) allow a coordination of the psychiatric care pathway","correct":true},{"idx":2,"proposition":"CMPs bring together multiple skills within multidisciplinary teams (doctors, psychologists, social workers, occupational therapists, sociotherapists, etc.) that ensure a diversified offer of care.","correct":true},{"idx":3,"proposition":"Permanent reception centres (CAPs) offer 24-hour response","correct":true},{"idx":4,"proposition":"Liaison psychiatry corresponds to liberal psychiatrists","correct":false,"justification":"Liaison psychiatry meets the needs for psychiatric interventions in non-psychiatric inpatient units, in the emergency reception departments of general hospitals or in medico-social structures."}],"type":"custom"}
{"_id":"soinspsy-psy-6","context":null,"enonce":"Regarding CACs:","item":"soinspsy","matiere":"psy","propositions":[{"idx":0,"proposition":"They are also called the U72","correct":true},{"idx":1,"proposition":"Patients stay there for less than 2 days","correct":false,"justification":"Less than 3 days"},{"idx":2,"proposition":"It is an outpatient structure","correct":false,"justification":"Hospital structure"},{"idx":3,"proposition":"They are intended for crisis situations","correct":true},{"idx":4,"proposition":"This is the psychiatry side of the somatic UAA","correct":false,"justification":"U72s are different from psychiatric UAAs"}],"type":"custom"}
{"_id":"somatopsy-psy-2","context":null,"enonce":"Regarding the diagnosis of these disorders:","item":"somatopsy","matiere":"psy","propositions":[{"idx":0,"proposition":"There are two main somatoform disorders: somatization disorder and neurological disorder","correct":false,"justification":"There are three main somatoform disorders: somatization disorder, conversion disorder and pain disorder"},{"idx":1,"proposition":"The necessary additional assessments of non-psychiatric medical pathologies are therefore to be carried out, but it is also necessary to know how to stop them once the psychiatric diagnosis has been made.","correct":true},{"idx":2,"proposition":"Psychiatrists distinguish conversion disorders according to the sphere of neurological appearance preponderant of the symptoms","correct":true},{"idx":3,"proposition":"This is called motor or sensory conversion disorder only.","correct":false,"justification":"Thus we will speak of conversion disorder of motor, sensory \/ sensory type, and malaise \/ convulsion type"},{"idx":4,"proposition":"To maintain the diagnosis of pain disorder, it is necessary that the painful symptoms are then insufficiently explained by the associated non-psychiatric medical pathology","correct":true}],"type":"custom"}
{"_id":"fievrechr-infectio-1","context":null,"enonce":"Regarding prolonged fevers","item":"fievrechr","matiere":"infectio","propositions":[{"idx":0,"proposition":"Questioning and physical examination, if necessary repeated, are the two key stages of etiological diagnosis","correct":true,"justification":"See item in the latest edition of the college"},{"idx":1,"proposition":"The management strategy for a patient with prolonged fever must be methodical and persistent","correct":true,"justification":"See item in the latest edition of the college"},{"idx":2,"proposition":"The tympanic pathway is never faulty","correct":false,"justification":"The tympanic route may be defective in case of obstruction of the external auditory canal (earwax plug)"},{"idx":3,"proposition":"In case of prolonged fever, it is essential that the body temperature is taken at irregular intervals and by varying the measuring tools","correct":false,"justification":"In case of prolonged fever it is essential that the body temperature is well taken in a standardized and regular way."},{"idx":4,"proposition":"Infective endocarditis is one of the main causes of prolonged fever","correct":true,"justification":"Infections, in general, are responsible for more than 40% of prolonged fevers"}],"type":"custom"}
{"_id":"FdRCV-cardio-8","context":null,"enonce":"Which of the following proposals define a metabolic syndrome?","item":"FdRCV","matiere":"cardio","propositions":[{"idx":0,"proposition":"Well-controlled high blood pressure","correct":true,"justification":"True, hypertension, or normotension treated"},{"idx":1,"proposition":"Fasting blood glucose at 1.05 g\/L","correct":true,"justification":"True, Fasting blood glucose > 1 g\/L"},{"idx":2,"proposition":"A waist circumference of 90 cm in men","correct":false,"justification":"Waist circumference> 94 cm in men and > 80 cm in women"},{"idx":3,"proposition":"Triglyceridemia at 2.05 g\/L","correct":true,"justification":"True, any triglyceridemia > 1.5 g\/L"},{"idx":4,"proposition":"HDL cholesterol at 0.55 g \/ L in women","correct":false,"justification":"HDL cholesterol< 0.5 g\/L in women and < 0.4 g\/L in men"}],"type":"custom"}
{"_id":"TNC-neuro-2","context":null,"enonce":"Regarding delirium syndrome:","item":"TNC","matiere":"neuro","propositions":[{"idx":0,"proposition":"Overactive confusion is most often accompanied by apathy","correct":false,"justification":"We find, as its name suggests, a psychomotor agitation that is in the foreground"},{"idx":1,"proposition":"Hypoactive confusion is often accompanied by patient opposition to care","correct":false,"justification":"The patient undergoes a frank psychomotor slowdown. No agitation, and no opposition to care most often"},{"idx":2,"proposition":"Overactive confusion is often mistaken for depression","correct":false,"justification":"This is the case of hypoactive confusion"},{"idx":3,"proposition":"There are mixed forms (hypoactive hyperactive) ","correct":true},{"idx":4,"proposition":"The most widely used screening tool is the MMSE","correct":false,"justification":"This is the CAM: Confusion Assessment Method, which lasts less than 10 minutes"}],"type":"custom"}
{"_id":"TTTKc-onco-9","context":null,"enonce":"Which of the following proposals about radiotherapy are true?","item":"TTTKc","matiere":"onco","propositions":[{"idx":0,"proposition":"The total dose depends on the patient's weight","correct":false,"justification":"The dose is fixed"},{"idx":1,"proposition":"The dose of radiation therapy in breast cancer depends on SBR grade and HER2 status","correct":false,"justification":"False"},{"idx":2,"proposition":"Radiation therapy usually lasts 5 to 6 weeks","correct":true},{"idx":3,"proposition":"Radiation therapy can cause diarrhea and nausea","correct":false,"justification":"No general effects"},{"idx":4,"proposition":"Radiation therapy may be accompanied by localized radiodermatitis","correct":true}],"type":"custom"}
{"_id":"anapathKc-onco-1","context":null,"enonce":"Which of these colours makes it possible to study fungi (fungi)?","item":"anapathKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Perls","correct":false,"justification":"Iron"},{"idx":1,"proposition":"Hemalun-Eosin","correct":false,"justification":"Classic fabrics"},{"idx":2,"proposition":"Polarized light","correct":false,"justification":"Be careful, it does not count as a coloring. This is a different microscopy technique"},{"idx":3,"proposition":"Red Congo","correct":false,"justification":"Amyloid deposits"},{"idx":4,"proposition":"Grocott","correct":true,"justification":"It is used in histology for the visualization of fungi, certain pathogens, basement membranes"}],"type":"custom"}
{"_id":"anapathKc-onco-3","context":null,"enonce":"Which of these stains can highlight beta-amyloid peptides?","item":"anapathKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Perls","correct":false,"justification":"Iron"},{"idx":1,"proposition":"Hemalun-Eosin","correct":false,"justification":"Classic fabrics"},{"idx":2,"proposition":"Polarized light","correct":false,"justification":"Be careful, it does not count as a coloring. This is a different microscopy technique"},{"idx":3,"proposition":"Red Congo","correct":true,"justification":"It is an acidic dye, that is, it tends to attach preferentially to basic structures."},{"idx":4,"proposition":"Grocott","correct":false,"justification":"It is used in histology for the visualization of fungi, certain pathogens, basement membranes"}],"type":"custom"}
{"_id":"anapathKc-onco-5","context":null,"enonce":"Which of these propositions are true?","item":"anapathKc","matiere":"onco","propositions":[{"idx":0,"proposition":"Histological analysis requires fixed samples","correct":true},{"idx":1,"proposition":"Cytological analysis requires fixed samples","correct":false,"justification":"Not necessarily. For example, the blood count does not require fixation"},{"idx":2,"proposition":"In indirect immunofluorescence, fluorochrome is provided by the second antibody","correct":true},{"idx":3,"proposition":"In direct immunofluorescence, fluorochrome is provided by the second antibody","correct":false,"justification":"Fluorochrome is directly attached to the first antibody"},{"idx":4,"proposition":"The search for fat contraindicates the fixation of the sample","correct":true}],"type":"custom"}
{"_id":"hemgenitale-gyn-3","context":null,"enonce":"Regarding definitions:","item":"hemgenitale","matiere":"gyn","propositions":[{"idx":0,"proposition":"Hypermenorrhea refers to periods that are too long","correct":false,"justification":"Menstruation is normal but too heavy (> 80 mL)"},{"idx":1,"proposition":"In macromenorrhea, menstruation is normal but too abundant","correct":false,"justification":"Periods are too long but of normal abundance (> 6 days)"},{"idx":2,"proposition":"In pllakimenorrhea, menstruation is too frequent and cycles are too short","correct":true},{"idx":3,"proposition":"Bleeding occurs outside the period","correct":true,"justification":"As opposed to menorrhagia"},{"idx":4,"proposition":"Menorrhagia is more abundant than metrorrhagia","correct":false,"justification":"Not necessarily. Does not fit into the definition"}],"type":"custom"}
{"_id":"transfusion-therapeutique-1","context":null,"enonce":"In case of intolerance observed to transfusion: ","item":"transfusion","matiere":"therapeutique","propositions":[{"idx":0,"proposition":"Transfusion is stopped and the route is removed first","correct":false,"justification":"We leave the route first, which will be very useful in case of hemodynamic instability"},{"idx":1,"proposition":"We scope the patient","correct":true,"justification":"Cardiovascular parameters are monitored"},{"idx":2,"proposition":"Adverse reaction is reported to haemovigilance","correct":true},{"idx":3,"proposition":"The patient is transferred to intensive care","correct":false,"justification":"Only in case of relevant clinical-biological arguments. Transfusion intolerance can have multiple explanations, many of them benign, and be quite transient"},{"idx":4,"proposition":"Transfusion continues, unless intolerance impacts constants","correct":false,"justification":"Transfusion is stopped in case of intolerances"}],"type":"custom"}
{"_id":"transfusion-therapeutique-2","context":null,"enonce":"What to transfer preferentially to an AB+ patient?","item":"transfusion","matiere":"therapeutique","propositions":[{"idx":0,"proposition":"A+","correct":false},{"idx":1,"proposition":"B+","correct":false},{"idx":2,"proposition":"AB+","correct":true,"justification":"Unless we cannot do otherwise, we transfuse the same group and the same rhesus"},{"idx":3,"proposition":"O+","correct":false},{"idx":4,"proposition":"Such a patient cannot be transfused","correct":false}],"type":"custom"}
{"_id":"oedemes-nephro-2","context":null,"enonce":"Regarding the etiologies of edema and their pathophysiology:","item":"oedemes","matiere":"nephro","propositions":[{"idx":0,"proposition":"During heart failure, decreased cardiac output leads to increased redistribution of blood flow to the kidney","correct":false,"justification":"There is a decrease in renal blood flow, thus a decrease in \"effective\" blood volume. This activates the mechanisms responsible for water retention"},{"idx":1,"proposition":"Edema is formed especially during severe acute oligo-anuric renal failure","correct":true},{"idx":2,"proposition":"Edema is not seen in chronic renal failure","correct":false,"justification":"Edema can be seen in the pre-terminal stage"},{"idx":3,"proposition":"The regulation of the sodium and water balance remains globally assured in chronic non-pre-terminal renal failure","correct":true},{"idx":4,"proposition":"In nephrotic syndrome, the decrease in oncotic pressure causes hypovolemia and RAAS activation","correct":true}],"type":"custom"}
{"_id":"pratiquespro-sp-5","context":null,"enonce":"Regarding the certification of health facilities","item":"pratiquespro","matiere":"sp","propositions":[{"idx":0,"proposition":"It is mandatory","correct":true},{"idx":1,"proposition":"Evaluation is internal","correct":false,"justification":"The evaluation is done by external stakeholders"},{"idx":2,"proposition":"They concern public and private health institutions","correct":true},{"idx":3,"proposition":"It is carried out by independent professionals","correct":true},{"idx":4,"proposition":"It is implemented by the ARS","correct":false,"justification":"It is implemented by the HAS"}],"type":"custom"}
{"_id":"MICI-HGE-1","context":null,"enonce":"Regarding Crohn's disease:","item":"MICI","matiere":"HGE","propositions":[{"idx":0,"proposition":"Epithelio-gigantocellular granulomas without caseous necrosis are very suggestive of Crohn's disease","correct":true},{"idx":1,"proposition":"Resection surgery is considered at the stage of complications and should be as conservative as possible","correct":true},{"idx":2,"proposition":"More than 50% of patients are operated on within 10 years of diagnosis","correct":true},{"idx":3,"proposition":"The life expectancy of patients is close to that of the general population","correct":true},{"idx":4,"proposition":"Tobacco is a protective factor against Crohn's disease","correct":false,"justification":"This is the case for UC"}],"type":"custom"}
{"_id":"MICI-HGE-3","context":null,"enonce":"Regarding ulcerative colitis:","item":"MICI","matiere":"HGE","propositions":[{"idx":0,"proposition":"Active smoking has a protective effect on UC","correct":true},{"idx":1,"proposition":"Following the diagnosis of sclerosing cholangitis, it will be necessary to evoke the diagnosis of UC","correct":true,"justification":"The association is common between the two"},{"idx":2,"proposition":"Endoscopic signs are very specific","correct":false,"justification":"Endoscopic signs are varied and non-specific"},{"idx":3,"proposition":"The evolution is generally done by flare-ups separated from more or less long periods of remission","correct":true},{"idx":4,"proposition":"Severe flare-up of severe acute colitis occurs in 20% of patients","correct":true}],"type":"custom"}
{"_id":"AV--ophtalmo-0","context":null,"enonce":"Regarding progressive visual acuity decline:","item":"AV-","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"A transparency of normal environments points to corneal damage","correct":false,"justification":"Transparency of normal media without improvement by optical correction = damage to the retinal macula or optic nerve damage"},{"idx":1,"proposition":"Improvement by optical correction signs optic nerve damage","correct":false,"justification":"It is a refractive disorder"},{"idx":2,"proposition":"Damage to the isolated optic nerve is accompanied by an impairment of the transparency of the media","correct":false,"justification":"The damage (such as the integrity) of the optic nerve does not impact the transparency of the environments"},{"idx":3,"proposition":"The clinical examination concerns only the diseased eye","correct":false,"justification":"It is bilateral and comparative"},{"idx":4,"proposition":"The transparency of the media is normal during an isolated attack of the macula","correct":true,"justification":"It has been clearly specified \"An isolated attack of the macula\""}],"type":"custom"}
{"_id":"AV--ophtalmo-2","context":null,"enonce":"Regarding visual field alterations:","item":"AV-","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"They may reflect impaired peripheral vision","correct":true},{"idx":1,"proposition":"They are accompanied by a systematic decrease in visual acuity","correct":false,"justification":"Only if the campimetric attack reaches the central region"},{"idx":2,"proposition":"Toxic optic neuropathies are most often unilateral","correct":false,"justification":"Whether it is a toxic or metabolic etiology, there is bilateral and progressive involvement"},{"idx":3,"proposition":"Tumors developed at the expense of nerve fibers in the optic nerve are meningiomas","correct":false,"justification":"These are gliomas. Meningiomas are developed from the optic nerve sheath"},{"idx":4,"proposition":"Sphenoid meningiomas can compress optic pathways","correct":true}],"type":"custom"}
{"_id":"grossessepatho-gyn-2","context":null,"enonce":"Regarding first trimester hemorrhages:","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"proposition":"In a normal pregnancy, the ovular sac is visible as early as 2SA","correct":false,"justification":"In a normal pregnancy, the ocular sac is visible as early as 5 weeks of amenorrhea (AS) in the form of an intrauterine fluid image surrounded by an echogenous crown (the trophoblast)."},{"idx":1,"proposition":"The embryo and its cardiac activity become visible as early as 3 SA","correct":false,"justification":"The embryo and its cardiac activity become visible between 5.5 and 6 SA"},{"idx":2,"proposition":"Hemorrhages with clots and \"debris\" are in favor of a spontaneous abortion","correct":true},{"idx":3,"proposition":"A soft, permeable cervix in favor of a spontaneous abortion","correct":true},{"idx":4,"proposition":"Painless uterine mobilization is in favor of spontaneous abortion","correct":true,"justification":"TRUE\""}],"type":"custom"}
{"_id":"grossessepatho-gyn-8","context":null,"enonce":"Which of these proposals is (are) in favor of a placenta previa:","item":"grossessepatho","matiere":"gyn","propositions":[{"idx":0,"proposition":"Abundant, recurrent, red, coagulable blood hemorrhage","correct":true},{"idx":1,"proposition":"a flexible uterus (between contractions) and painless","correct":true,"justification":"Unlike retroplacental hematoma"},{"idx":2,"proposition":"A presentation of the normal fetus most often","correct":false,"justification":"Fetal presentation is frequently pathological (transverse or seat)"},{"idx":3,"proposition":"Fetal cardiac activity is often absent","correct":false,"justification":"On the contrary, fetal cardiac activity is generally well perceived"},{"idx":4,"proposition":"A history of multiparity of women","correct":true,"justification":"Multiparity, history of curettage, uterine surgery or caesarean section are risk factors for placenta previa."}],"type":"custom"}
{"_id":"pbsuitescouches-gyn-4","context":null,"enonce":"Regarding complications of breastfeeding:","item":"pbsuitescouches","matiere":"gyn","propositions":[{"idx":0,"proposition":"A normal milky rise is not accompanied by fever","correct":false,"justification":"infra)The milky rise is a natural phenomenon occurring on the 2nd–3rd day of postpartum, which may be accompanied by a transient fever at 38 ° C and doule'is very common that this passage is accompanied by a fever and breast pain or discomfort"},{"idx":1,"proposition":"It is self-limiting within a few days, in the absence of nipple stimulation","correct":true},{"idx":2,"proposition":"In case of galactophoritis, breastfeeding should be stopped","correct":true},{"idx":3,"proposition":"Active antibiotic treatment with Staphylococcus aureus (penicillin M type, 2–3 g\/d) should be administered for 10 days, in addition to symptomatic treatment.","correct":false,"justification":"Active antibiotic treatment with Staphylococcus aureus (penicillin M type, 2–3 g\/d) should be administered for 10 days, in addition to symptomatic treatment."},{"idx":4,"proposition":"Breastfeeding should be stopped in case of breast abscess","correct":true}],"type":"custom"}
{"_id":"dysphagie-HGE-7","context":null,"enonce":"Which of the following are causes of esophageal dysphagia without organ damage?","item":"dysphagie","matiere":"HGE","propositions":[{"idx":0,"proposition":"Primitive achalasia","correct":true},{"idx":1,"proposition":"Movement disorders","correct":true},{"idx":2,"proposition":"Caustic stenosis","correct":false,"justification":"Lesional etiology"},{"idx":3,"proposition":"Peptic stenosis","correct":false,"justification":"Lesional etiology"},{"idx":4,"proposition":"Eosinophilic esophagitis","correct":false,"justification":"Histological lesions"}],"type":"custom"}
{"_id":"toux-pneumo-1","context":null,"enonce":"Regarding chronic cough:","item":"toux","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Cough may be the only symptom of asthma","correct":true},{"idx":1,"proposition":"The iatrogenic cause is very marginal","correct":false,"justification":"It is one of the 4 major causes, along with asthma, chronic rhinorrhea and GERD."},{"idx":2,"proposition":"The appearance of a cough in a chronic smoker must suggest bronchial cancer","correct":true},{"idx":3,"proposition":"Treatment of chronic cough is exclusively symptomatic","correct":false,"justification":"It must be above all etiological"},{"idx":4,"proposition":"Chronic cough associated with purulent bronchiorhea is an important sign of bronchiectasis","correct":true}],"type":"custom"}
{"_id":"Kcfoie-onco-2","context":null,"enonce":"Regarding focal nodular hyperplasia (UFH):","item":"Kcfoie","matiere":"onco","propositions":[{"idx":0,"proposition":"It is predominantly female","correct":true},{"idx":1,"proposition":"It is related to estrogen-progestins","correct":false,"justification":"Unlike hepatocellular adenoma, focal nodular hyperplasia is not related to estrogen-progestin"},{"idx":2,"proposition":"There is a peripheral fibrous scar","correct":false,"justification":"The fibrous scar is central"},{"idx":3,"proposition":"UFH is an area of liver receiving only portal blood and not arterial blood","correct":false,"justification":"UFH, on the other hand, receives only arterial blood (and no portal blood at all)"},{"idx":4,"proposition":"Biopsy is contraindicated in view of the risk of bleeding","correct":false,"justification":"It is not contraindicated (unlike the hydatid cyst for example) and it is even sometimes necessary"}],"type":"custom"}
{"_id":"Kcfoie-onco-9","context":null,"enonce":"Which of the following are true for hepatic adenoma?","item":"Kcfoie","matiere":"onco","propositions":[{"idx":0,"proposition":"It occurs preferentially in humans","correct":false,"justification":"In women, just like UFH"},{"idx":1,"proposition":"It is hormone-dependent","correct":true,"justification":"True, favored by taking an oral estrogen-progestin contraception"},{"idx":2,"proposition":"It is a malignant tumor","correct":false,"justification":"Adenoma = benign (such as UFH, benign hemangioma and simple biliary cyst)"},{"idx":3,"proposition":"It can escalate and therefore requires monitoring","correct":true},{"idx":4,"proposition":"The most common complications are hemorrhage and malignant transformation","correct":true,"justification":"True as well as necrosis and rupture"}],"type":"custom"}
{"_id":"epistaxis-ORL-0","context":null,"enonce":"General and anatomy:","item":"epistaxis","matiere":"ORL","propositions":[{"idx":0,"proposition":"An epistaxis is a bloody discharge from the bronchi","correct":false,"justification":"From the nasal cavities"},{"idx":1,"proposition":"This bleeding is very common and mostly benign.","correct":true},{"idx":2,"proposition":"It is never a real medical-surgical emergency","correct":false,"justification":"In some cases, it can become, by its abundance, its repetition or the fragility of the terrain, a real medical-surgical emergency."},{"idx":3,"proposition":"The lining of the nasal cavity is also called the pituitary mucosa","correct":true},{"idx":4,"proposition":"The mucosa of the nasal cavity is very thick and highly vascularized","correct":false,"justification":"It has the particularity of being fine, in direct contact with the skeleton, and richly vascularized — three characteristics explaining the frequency of epistaxis"}],"type":"custom"}
{"_id":"epistaxis-ORL-5","context":null,"enonce":"Regarding diagnosis and general examination:","item":"epistaxis","matiere":"ORL","propositions":[{"idx":0,"proposition":"Management of severe epistaxis will most often require vitamin K","correct":false,"justification":"Management of severe epistaxis will most often require previous tamponaking or placement of a double-balloon probe"},{"idx":1,"proposition":"In hemoptysis, bleeding is externalized during coughing efforts","correct":true},{"idx":2,"proposition":"Hematemesis is an epistaxis that is exteriorized through the mouth","correct":false,"justification":"Hematemesis: bleeding is mainly expressed through the mouth and during vomiting efforts. Blood comes from the digestive system"},{"idx":3,"proposition":"The side of the beginning of epistaxis is essential to determine because bilateral hemorrhages are rare","correct":true},{"idx":4,"proposition":"It is essential to quickly place a venous line","correct":true}],"type":"custom"}
{"_id":"psyage-psy-0","context":null,"enonce":"General:","item":"psyage","matiere":"psy","propositions":[{"idx":0,"proposition":"Psychiatric disorders in the elderly are often underdiagnosed","correct":true},{"idx":1,"proposition":"Psychiatric disorders in the elderly are characterized by semiological specificities","correct":true},{"idx":2,"proposition":"Alzheimer's disease and related diseases are not only manifested by cognitive alterations","correct":true},{"idx":3,"proposition":"The iatrogenic risk associated with the use of psychotropic drugs is major in the elderly","correct":true},{"idx":4,"proposition":"Characterized depressive disorder is a common pathology in the elderly","correct":true}],"type":"custom"}
{"_id":"psyage-psy-1","context":null,"enonce":"Regarding the consultation:","item":"psyage","matiere":"psy","propositions":[{"idx":0,"proposition":"In the general population, it is estimated that 1 to 4% of people over the age of 65 suffer from a characterized depressive episode (EDC)","correct":true},{"idx":1,"proposition":"It can be considered normal to \"suffer and be sad as we get older\"","correct":false,"justification":"It is absolutely not normal to \"suffer and be sad as you get older\" because the prevalence of EDCs is less than 5 percent."},{"idx":2,"proposition":"The diagnostic criteria for the EDC of the elderly subject are the same as for the young subject","correct":true},{"idx":3,"proposition":"The reason for consulting older people suffering from EDC is often not a depressed mood","correct":true},{"idx":4,"proposition":"There are few age-related clinical specificities for anxiety disorders","correct":true}],"type":"custom"}
{"_id":"Frped-urg-0","context":null,"enonce":"Regarding the classification of Salter & Harris, which propositions are true?","item":"Frped","matiere":"urg","propositions":[{"idx":0,"proposition":"It concerns fractures of growth cartilage","correct":true,"justification":"Fractures between the metaphysis and the epiphysis"},{"idx":1,"proposition":"It concerns postmenopausal women","correct":false,"justification":"It concerns children and young adolescents (who still have growth cartilage)"},{"idx":2,"proposition":"They concern non-displaced fractures","correct":true},{"idx":3,"proposition":"Stage 2 indicates orthopaedic management alone","correct":true},{"idx":4,"proposition":"Stage 4 indicates orthopaedic management alone","correct":false,"justification":"Surgical management"}],"type":"custom"}
{"_id":"Exprenuptial-gyn-9","context":null,"enonce":"Which of the following are true?","item":"Exprenuptial","matiere":"gyn","propositions":[{"idx":0,"proposition":"Daughters born to mothers who consumed Distilbene (diethystilbestrol) during pregnancy (1950 to 1977) have an increased risk of uterine malformations","correct":true},{"idx":1,"proposition":"ACE inhibitors are teratogenic","correct":true},{"idx":2,"proposition":"Retinoic acid is teragotege","correct":true},{"idx":3,"proposition":"The determination of the blood group (ABO, complete rhesus, Kell) is part of the pre-conception assessment. Only 1 determination is required. ","correct":false,"justification":"False. 2 determinations are needed"},{"idx":4,"proposition":"If the mother is rhesus negative, it is interesting to determine the blood type of the future father. And if the latter is positive, a genotype of fetal rhesus may be prescribed from 9 weeks. ","correct":false,"justification":"False. Indeed, we can make a genotype of fetal rhesus if the father is rhesus + and if the mother is rhesus -, but it is done from 11 SA."}],"type":"custom"}
{"_id":"Exprenuptial-gyn-10","context":null,"enonce":"Which of the following are true?","item":"Exprenuptial","matiere":"gyn","propositions":[{"idx":0,"proposition":"Daughters born to mothers who consumed Distilbene (diethystilbestrol) during pregnancy (1950 to 1977) have an increased risk of uterine malformations","correct":true},{"idx":1,"proposition":"ACE inhibitors are teratogenic","correct":true},{"idx":2,"proposition":"Retinoic acid is teratogenic","correct":true},{"idx":3,"proposition":"The determination of the blood group (ABO, complete rhesus, Kell) is part of the pre-conception assessment. Only 1 determination is required. ","correct":false,"justification":"False. 2 determinations are needed"},{"idx":4,"proposition":"If the mother is rhesus negative, it is interesting to determine the blood type of the future father. And if the latter is positive, a genotype of fetal rhesus may be prescribed from 9 weeks. ","correct":false,"justification":"False. Indeed, we can make a genotype of fetal rhesus if the father is rhesus + and if the mother is rhesus -, but it is done from 11 SA."}],"type":"custom"}
{"_id":"Exprenuptial-gyn-11","context":null,"enonce":"If the mother is rhesus negative and the father rhesus positive, genotyping of fetal rhesus may be prescribed. This genotyping can be done from which week of amenorrhea?","item":"Exprenuptial","matiere":"gyn","propositions":[{"idx":0,"proposition":"11 SA","correct":true},{"idx":1,"proposition":"9 Ltd.","correct":false,"justification":"False"},{"idx":2,"proposition":"13 SA","correct":false,"justification":"False"},{"idx":3,"proposition":"8 Ltd.","correct":false,"justification":"False"},{"idx":4,"proposition":"30 Ltd.","correct":false,"justification":"False"}],"type":"custom"}
{"_id":"Mgenetiques-gyn-3","context":null,"enonce":"Regarding trisomy 21:","item":"Mgenetiques","matiere":"gyn","propositions":[{"idx":0,"proposition":"Multidisciplinary medical and psychosocial care is essential in case of trisomy 21","correct":true,"justification":"Family and patient"},{"idx":1,"proposition":"Trisomy 21 (T21), or Down syndrome, is a genetic disease linked to aneuploidy","correct":true,"justification":"Aneuploidy is an abnormal number of chromosomes (by excess or defect) so T21 (or Down syndrome in English) fits well into this framework."},{"idx":2,"proposition":"It is due to the presence of an extra chromosome 21 (3 chromosomes instead of 2)","correct":true,"justification":"This does not mean that the chromosome is always free and homogeneous since a translocation can be found"},{"idx":3,"proposition":"Diagnostic confirmation relies on an increase in genes from chromosome 21 to genetic sequencing","correct":false,"justification":"No sequencing, a karyotype is enough.  (Note: in a few years maybe...)"},{"idx":4,"proposition":"It is the most common chromosomal abnormality in France","correct":true}],"type":"custom"}
{"_id":"Mgenetiques-gyn-5","context":null,"enonce":"Regarding trisomy 21:","item":"Mgenetiques","matiere":"gyn","propositions":[{"idx":0,"proposition":"Only a fetal karyotype makes it possible to make an antenatal diagnosis of Trisomy 21 certainty","correct":true},{"idx":1,"proposition":"Antenatal diagnosis is systematically proposed during pregnancy","correct":false,"justification":"Antenatal \"screening\" is systematically offered during pregnancy"},{"idx":2,"proposition":"Antenatal screening involves making a karyotype of the fetus","correct":false,"justification":"This is the case with diagnosis, not screening. These are two very different things that must be distinguished"},{"idx":3,"proposition":"Screening makes it possible to distinguish pregnancies considered to be at risk for which a diagnostic procedure will be proposed","correct":true},{"idx":4,"proposition":"Antenatal screening measures screen approximately 99.9% of T21s","correct":false,"justification":"Approximately 85% of T21"}],"type":"custom"}
{"_id":"Mgenetiques-gyn-8","context":null,"enonce":"Concerning trisomy 21 antenatally:","item":"Mgenetiques","matiere":"gyn","propositions":[{"idx":0,"proposition":"The woman is free to accept or refuse antenatal screening","correct":true,"justification":"It is mandatory for the physician to offer, but not for the patient to accept"},{"idx":1,"proposition":"The Lheman Score must be greater than or equal to 3\/9 for the risk estimate to be reliable","correct":false,"justification":"Herman score greater than or equal to 4\/9. The Lheman score does not exist."},{"idx":2,"proposition":"An antenatal diagnosis is offered to women with a 1\/50 ≥ risk of having a fetus carrying T21","correct":true,"justification":"Karyotype study. The threshold has changed since the routine introduction of circulating fetal DNA analysis, which is proposed between 1\/1000 and 1\/51."},{"idx":3,"proposition":"The markers measured in the 2nd trimester are β-HCG and α-fetoprotein in particular","correct":true,"justification":"This examination is not mandatory but the information must be given to all pregnant women, regardless of their age"},{"idx":4,"proposition":"The discovery of hygroma colli (or cystic) is frequently associated with a fetal chromosomal abnormality","correct":true}],"type":"custom"}
{"_id":"exanthemeped-infectio-3","context":null,"enonce":"With regard to eruptive diseases of childhood, what are the right proposals?","item":"exanthemeped","matiere":"infectio","propositions":[{"idx":0,"proposition":"Measles can be complicated by pulmonary superinfection or encephalitis.","correct":true,"justification":"True, MMR vaccination (to M12 and M16-18) is mandatory to prevent these complications, which are even more serious if the infection occurs in adulthood."},{"idx":1,"proposition":"The rash characteristic of Kawasaki disease does not affect the plantar surface of the extremities.","correct":false,"justification":"False, erythematous involvement of the palms and soles with secondary desquamation is one of the criteria frequently found"},{"idx":2,"proposition":"Rubella is a benign disease for children","correct":true,"justification":"True, the disease is often asymptomatic. However, vaccination is mandatory to protect pregnant women from the risk of fetal malformation."},{"idx":3,"proposition":"Roseola can be complicated by anemia","correct":false,"justification":"False, it is a complication of megalerythema, infection with parvovirus B19 that gives PRCA."},{"idx":4,"proposition":"Scarlet fever is due to an infection with HHV6, also called 6th disease","correct":false,"justification":"False, this is the case of the sudden exanthema. Scarlet fever is a bacterial infection caused by Streptococcus pyogenes (GAS = Group A Beta-Haemolytic Streptococcus). Diagnosis is made by RDT and treatment is based on amoxicillin."}],"type":"custom"}
{"_id":"prurit-dermato-1","context":null,"enonce":"Regarding the basics of pruritus:","item":"prurit","matiere":"dermato","propositions":[{"idx":0,"proposition":"Physiological prurirut is more important in the evening","correct":true},{"idx":1,"proposition":"Each individual scratches many times in a day without causing any major inconvenience.","correct":true},{"idx":2,"proposition":"Pruritus becomes pathological when it occurs more than 5 times a day","correct":false,"justification":"Pruritus becomes pathological when it induces scratching lesions"},{"idx":3,"proposition":"Pruritus becomes pathological when it encourages consultation because of its impact","correct":true},{"idx":4,"proposition":"The pathophysiology of pruritus is complex","correct":true}],"type":"custom"}
{"_id":"suiviMIT-infectio-1","context":null,"enonce":"Concerning infectious disease surveillance","item":"suiviMIT","matiere":"infectio","propositions":[{"idx":0,"proposition":"During direct transmission the infectious agent passes from the eye to the cibel directly","correct":true},{"idx":1,"proposition":"Inciscidence: this is the number of new cases of infection in a population, during a given period, compared to the entire population followed during the period","correct":true},{"idx":2,"proposition":"The attack rate is calculated by relating the number of new infections during a specified period to the total number of uninfected contacts at the beginning of the period.","correct":true},{"idx":3,"proposition":"Sensitivity is the proportion of subjects classified as sick (= whose test result is positive) among all subjects actually affected by the disease","correct":true},{"idx":4,"proposition":"Specificity: this is the proportion of subjects classified as non-sick (= whose test result is negative) among all subjects not affected by the disease","correct":true}],"type":"custom"}
{"_id":"suiviMIT-infectio-2","context":null,"enonce":"Concerning infectious disease surveillance","item":"suiviMIT","matiere":"infectio","propositions":[{"idx":0,"proposition":"Positive predictive value and negative predictive value are indcators of the diagnostic test","correct":false,"justification":"Are extrinsic indicators because they depend on the prevalence of the disease in the population"},{"idx":1,"proposition":"If the disease is rare, a very specific test may still have poor positive predictive value","correct":true},{"idx":2,"proposition":"Negative predictive value: this is the proportion of non-sick subjects among subjects classified as non-sick (whose test result is negative)","correct":true},{"idx":3,"proposition":"The list of diseases to be evicted is set by the High Council of Public Health","correct":true},{"idx":4,"proposition":"Public Health France has a regional network made up of interregional epidemiology units (CIRE) which relay its actions and carry out part of its missions at the regional level","correct":true}],"type":"custom"}
{"_id":"suiviMIT-infectio-4","context":null,"enonce":"How many notifiable diseases were there (in 2018)?","item":"suiviMIT","matiere":"infectio","propositions":[{"idx":0,"proposition":"34","correct":true,"justification":"True, 32 infectious diseases and 2 non-infectious diseases (mesotheliomas and lead poisoning in minor children)"},{"idx":1,"proposition":"45","correct":false,"justification":"False"},{"idx":2,"proposition":"18","correct":false,"justification":"False"},{"idx":3,"proposition":"58","correct":false,"justification":"False"},{"idx":4,"proposition":"15","correct":false,"justification":"Full list here: https:\/\/www.santepubliquefrance.fr\/maladies-a-declaration-obligatoire\/liste-des-maladies-a-declaration-obligatoire"}],"type":"custom"}
{"_id":"suiviMIT-infectio-6","context":null,"enonce":"Which of the following are notifiable diseases?","item":"suiviMIT","matiere":"infectio","propositions":[{"idx":0,"proposition":"Botulism","correct":true},{"idx":1,"proposition":"Measles","correct":true},{"idx":2,"proposition":"Lead poisoning in adults","correct":false,"justification":"Lead poisoning in minor children"},{"idx":3,"proposition":"Mesothelioma","correct":true},{"idx":4,"proposition":"Osteomyelitis","correct":false,"justification":"False. The full list is available on santepubliquefrance.fr"}],"type":"custom"}
{"_id":"sarcoidose-pneumo-1","context":null,"enonce":"Regarding sarcoidosis","item":"sarcoidose","matiere":"pneumo","propositions":[{"idx":0,"proposition":"The diagnosis of sarcoidosis is based on a compatible clinical picture, the detection of granulomas in histology, and the elimination of other granulomatosis","correct":true},{"idx":1,"proposition":"Half of patients with sarcoidosis have a spontaneously favorable course of their disease within 2 months of diagnosis","correct":false,"justification":"Half of sarcoidosis patients have a spontaneously favorable course of their disease within 2 years of diagnosis"},{"idx":2,"proposition":"Some sarcoidosis attacks can involve the functional prognosis of the affected organ (lung, eye, liver, kidney) or the vital prognosis (lung, heart, central nervous system)","correct":true},{"idx":3,"proposition":"Pulmonary fibrosis is the main progressive risk of sarcoidosis:","correct":true},{"idx":4,"proposition":"Oral corticosteroid therapy is the main general treatment","correct":true}],"type":"custom"}
{"_id":"sarcoidose-pneumo-3","context":null,"enonce":"Regarding sarcoidosis, what are the true propositions? (one or more exact propositions)","item":"sarcoidose","matiere":"pneumo","propositions":[{"idx":0,"proposition":"Extrarespiratory manifestations are very polymorphic","correct":true},{"idx":1,"proposition":"Ankle biarthritis is highly evocatric when associated with mediastinopulmonary involvement, affirming the systemic nature of the disease","correct":true},{"idx":2,"proposition":"Skin involvement is mainly observed in chronic forms of sarcoidosis and must seek ENT involvement","correct":true},{"idx":3,"proposition":"Sarcoidosis is the most common cause of erythema nodosum in France","correct":false,"justification":"Sarcoidosis remains a relatively rare pathology, compared to streptococcal infections for example."},{"idx":4,"proposition":"The combination of erythema nodosum and hilar and mediastinal lymphadenopathy defines Löfgren's syndrome","correct":true}],"type":"custom"}
{"_id":"systemeconv-sp-1","context":null,"enonce":"Which of these propositions are true?","item":"systemeconv","matiere":"sp","propositions":[{"idx":0,"proposition":"The national convention organizes the relationship between private doctors and health insurance","correct":false,"justification":""},{"idx":1,"proposition":"The national convention is concluded between UNCAM and the unions of liberal doctors.","correct":true},{"idx":2,"proposition":"The agreement is renewed every 3 years","correct":false,"justification":"The agreement is renewed every 5 years"},{"idx":3,"proposition":"There are three non-exclusive methods of remuneration for physicians: fee-for-service, lump sum payment and remuneration based on public health objectives.","correct":true},{"idx":4,"proposition":"Fee-for-service payments weigh very little on physicians' remuneration","correct":false,"justification":"This is the basis of remuneration\""}],"type":"custom"}
{"_id":"medmalade-psy-4","context":null,"enonce":"Regarding the position of the doctor in the doctor-patient relationship","item":"medmalade","matiere":"psy","propositions":[{"idx":0,"proposition":"The physician must pour his knowledge on the patient to show him that he is competent","correct":false,"justification":"The doctor must, of course, provide scientific information, but also moral support to the patient and must take into account the representations and actions of the patient concerning his health."},{"idx":1,"proposition":"Medical studies lead to the construction of a secular and experimental theory of diseases","correct":false,"justification":"Medical studies lead to the construction of a learned theory of diseases"},{"idx":2,"proposition":"The doctor acquires semiological, nosographic, and therapeutic knowledge","correct":true},{"idx":3,"proposition":"The disease is \"the feeling of pain or discomfort unexplained by the patient\"","correct":false,"justification":"The definition of the disease by the French Academy of Medicine is \"a clinical entity that is perfectly defined by its etiology and pathophysiology as well as by its symptomatic and clinical presentation or by a well-identified combination of clinical signs\""},{"idx":4,"proposition":"A disease is a set of symptoms and clinical signs due to an underlying organic pathology","correct":true,"justification":"TRUE\""}],"type":"custom"}
{"_id":"erreurs-sp-2","context":null,"enonce":"Which of the following are true?","item":"erreurs","matiere":"sp","propositions":[{"idx":0,"proposition":"A morbidity and mortality review is a personal and prospective analysis of events that cause harm to a patient","correct":false,"justification":"Collective, retrospective and systemic analysis of cases marked by the occurrence of a death, a complication, or an event that could have caused harm to a patient."},{"idx":1,"proposition":"The main purpose of morbidity and mortality reviews is to publish them in journals at Impact-Factor > 30","correct":false,"justification":"Implementation of actions to improve patient care and safety of care."},{"idx":2,"proposition":"It is a global analysis of the situation, taking into account all the elements (organizational, technical and human) in interaction that have contributed to the care of a patient.","correct":true},{"idx":3,"proposition":"It makes it possible to go beyond the sole reflection centered on one or more individuals.","correct":true},{"idx":4,"proposition":"At the end of the analysis, the people who made the mistakes are identified and punished.","correct":false,"justification":"At the end of the analysis, lessons can be learned about existing strengths and vulnerabilities in order to carry out actions to improve the quality and safety of care."}],"type":"custom"}
{"_id":"erreurs-sp-6","context":null,"enonce":"Regarding root cause analysis:","item":"erreurs","matiere":"sp","propositions":[{"idx":0,"proposition":"It can be conducted as part of an MMR","correct":true,"justification":"Or a CREX (Feedback Committee)"},{"idx":1,"proposition":"It is forbidden to conduct it within the framework of a feedback committee","correct":false,"justification":"This is one of the possible frameworks."},{"idx":2,"proposition":"The tree of causes is one of the methods of ACR","correct":true},{"idx":3,"proposition":"The CAUTION method is a method of ACT","correct":false,"justification":"3 ACR methods: cause tree, alarm method and grid, and the ORION method (r)"},{"idx":4,"proposition":"The ORION method is an ACR method","correct":true}],"type":"custom"}
{"_id":"diarrheeinf-infectio-4","context":null,"enonce":"What is the first-line treatment for a non-severe Clostridium difficile infection in hospitalization?","item":"diarrheeinf","matiere":"infectio","propositions":[{"idx":0,"proposition":"Vancomycin PO","correct":true,"justification":"True, digestive (local) so no need for blood bioavailability. Oral vancomycin is now the first-line treatment recommended by most learned societies, including the American Society of Infectious Diseases."},{"idx":1,"proposition":"Vancomycin IV","correct":false,"justification":"Per Os"},{"idx":2,"proposition":"Vancomycin IM","correct":false,"justification":"Per Os"},{"idx":3,"proposition":"Metronidazole IV","correct":false,"justification":"Vancomycin PO"},{"idx":4,"proposition":"Metronidazole PO","correct":false,"justification":"Vancomycin PO"}],"type":"custom"}
{"_id":"certifsport-nutri-2","context":null,"enonce":"Regarding the Ruffier-Dickson test:","item":"certifsport","matiere":"nutri","propositions":[{"idx":0,"proposition":"It is defined by taking the pulse just before, just after and 2 minutes after 60 push-ups","correct":false,"justification":"30 flexions (the rest is right)"},{"idx":1,"proposition":"A score below 0 is abnormal","correct":false,"justification":"A score above 15 is abnormal"},{"idx":2,"proposition":"A score above 15 is normal","correct":false,"justification":"A score below 0 is normal"},{"idx":3,"proposition":"The formula is: (P0 + P1 + P2 200)\/100","correct":true},{"idx":4,"proposition":"It is quick to do (less than 5 minutes)","correct":true}],"type":"custom"}
{"_id":"certifsport-nutri-3","context":null,"enonce":"Regarding the different metabolisms:","item":"certifsport","matiere":"nutri","propositions":[{"idx":0,"proposition":"Alactic anaerobic concerns long-term efforts","correct":false,"justification":"Very short efforts, of a few seconds"},{"idx":1,"proposition":"Efforts of a few minutes use glycogen","correct":true},{"idx":2,"proposition":"Prolonged efforts required oxidative metabolism","correct":true},{"idx":3,"proposition":"Lactic anaerobic is dependent on glycogen","correct":true},{"idx":4,"proposition":"Alactic anaerobic is dependent on oxygen","correct":false,"justification":"From the ATP"}],"type":"custom"}
{"_id":"SEP-neuro-2","context":null,"enonce":"About the clinic:","item":"SEP","matiere":"neuro","propositions":[{"idx":0,"proposition":"Tobacco increases the risk and worsens the course of MS","correct":true},{"idx":1,"proposition":"The myelin sheath and axon are the target of the immune system","correct":true,"justification":"It is a demyelinating disease, so especially myelin"},{"idx":2,"proposition":"Inter-individual variability in the topography of clinical symptoms is zero","correct":false,"justification":"The clinical symptoms of flare-ups are related to the location of the plaque, which explains their diversity"},{"idx":3,"proposition":"In most cases, the onset of symptoms is brutal","correct":false,"justification":"Neurological symptoms most often set in (85 to 90% of cases) subacutely, within hours or days, and then regress, defining the flare-up. More rarely, symptoms are insidious from the outset, worsening over several months or years (10 to 15% of cases)."},{"idx":4,"proposition":"A flare-up is defined as the appearance of new symptoms, the recurrence of old symptoms, or the worsening of pre-existing symptoms.","correct":true}],"type":"custom"}
{"_id":"splenomeg-HGE-0","context":null,"enonce":"Regarding sickle cell disease:","item":"splenomeg","matiere":"HGE","propositions":[{"idx":0,"proposition":"It is also called: falciparum anemia","correct":false,"justification":"Sickle cell anemia"},{"idx":1,"proposition":"It is also called: hemoglobin C","correct":false,"justification":"Hemoglobinosis S"},{"idx":2,"proposition":"It was formerly called: sicklemia","correct":true},{"idx":3,"proposition":"It is a genetic disease","correct":true},{"idx":4,"proposition":"It can cause developmental delays","correct":true}],"type":"custom"}
{"_id":"osteoporose-rhumato-1","context":null,"enonce":"Regarding BMD:","item":"osteoporose","matiere":"rhumato","propositions":[{"idx":0,"proposition":"BMD measurement can be artificially increased by osteoarthritic injuries or vertebral fractures","correct":true},{"idx":1,"proposition":"In both sexes, the maximum BMD value is reached at the end of growth and corresponds to the peak of bone mass (between 20 and 30 years)","correct":true},{"idx":2,"proposition":"There is no genetic factor in BMD","correct":false,"justification":"Genetic determinism is very important"},{"idx":3,"proposition":"Bone loss is greater for trabecular tissue-rich skeletal sites","correct":true},{"idx":4,"proposition":"In humans, there is no age-related bone loss","correct":false,"justification":"There is one and it is linear"}],"type":"custom"}
{"_id":"fievreaigue-infectio-3","context":null,"enonce":"Regarding acute fever","item":"fievreaigue","matiere":"infectio","propositions":[{"idx":0,"proposition":"Diabetes, especially poorly balanced, is particularly vulnerable to Staphylococcus aureus infections and surgical site infections","correct":true},{"idx":1,"proposition":"Infection of ascites fluid should be routinely investigated in cirrhotic patients","correct":true},{"idx":2,"proposition":"ƒƒ HIV: below 1500 CD4\/mm3 lymphocytes, opportunistic infection should be systematically sought","correct":false,"justification":"The threshold is 200 CD4\/mm3"},{"idx":3,"proposition":"Any fever returning from the tropics is malaria until proven otherwise and requires a diagnostic test (smear\/thick drop or other)","correct":true},{"idx":4,"proposition":"It is most often not recommended to administer antibiotics as a diagnostic test","correct":true}],"type":"custom"}
{"_id":"AMP-gyn-6","context":null,"enonce":"What are the conditions for male gamete donation?","item":"AMP","matiere":"gyn","propositions":[{"idx":0,"proposition":"Total anonymization","correct":true},{"idx":1,"proposition":"Gratuitousness","correct":true},{"idx":2,"proposition":"An age between 18 and 40 years old","correct":false,"justification":"Written consent"},{"idx":3,"proposition":"v","correct":false,"justification":"be 'healthy'"},{"idx":4,"proposition":"v","correct":false}],"type":"custom"}
{"_id":"anemie-hemato-3","context":null,"enonce":"Regarding anemias","item":"anemie","matiere":"hemato","propositions":[{"idx":0,"proposition":"Diagnosis of paroxysmal hemoglobinuria nocture is based on immunophenotyping of blood cells with overexpression of CD55 and CD59","correct":false,"justification":"Diagnosis is based on immunophenotyping of blood cells that shows defective expression of CD55 and CD59"},{"idx":1,"proposition":"Vitamin B12 deficiencies are most commonly caused by Biermer's anemia","correct":true},{"idx":2,"proposition":"In inflammatory anemia, serum iron is low and blood ferritin is low","correct":false,"justification":"Serum iron is low, blood ferritin normal or increased"},{"idx":3,"proposition":"Reticulocytes should be requested in front of newly discovered anemia, most often","correct":true},{"idx":4,"proposition":"Measurements of serum iron, blood ferritin, vitamin B12 and blood folate, when necessary, should be performed prior to treatment","correct":true}],"type":"custom"}
{"_id":"diuretiques-nephro-0","context":null,"enonce":"Regarding the different diuretics:","item":"diuretiques","matiere":"nephro","propositions":[{"idx":0,"proposition":"Diuretics increase the elimination of sodium and water by the kidney","correct":true},{"idx":1,"proposition":"The diuretic action involves the inhibition of renal sodium reabsorption","correct":true},{"idx":2,"proposition":"There are four classes of diuretics","correct":true,"justification":"The proximals, those of the loop, the thiazide and those of the cortical collecting tube"},{"idx":3,"proposition":"Proximal diuretics are indicated in hypertension tritement","correct":false,"justification":"Proximal diuretics are acetazolamide and mannitol. Both are not indicated in hypertension, nor in the edematous state"},{"idx":4,"proposition":"Acetazolamide is a carbonic anhydrase inhibitor","correct":true}],"type":"custom"}
{"_id":"santepop-mpr-1","context":null,"enonce":"Regarding the epidemiology of disability in the world:","item":"santepop","matiere":"mpr","propositions":[{"idx":0,"proposition":"It is estimated that more than one million people live with a disability worldwide.","correct":false,"justification":"It is estimated that more than one billion people live with some form of disability, or about 15% of the world's population (based on population estimates for 2010)."},{"idx":1,"proposition":"The prevalence of disability is plummeting worldwide","correct":false,"justification":"This figure is higher than the previous WHO estimate, which dates back to the 1970s and suggested a proportion of around 10%"},{"idx":2,"proposition":"It is estimated that 15 million people have very severe functional difficulties worldwide.","correct":false,"justification":"The World Health Survey estimates that 110 million people (2.2%) have very severe functional difficulties, while the Global Burden of Disability Assessment indicates 190 million people (3.8%) with \"severe disability\" – equivalent to impairments caused by health problems such as quadriplegia, severe depression or blindness."},{"idx":3,"proposition":"Worldwide, it is estimated that there are approximately 350,000 children with severe disabilities.","correct":false,"justification":"For the global burden of disease, disability in children (0–14 years) is also measured, and it is estimated to affect 95 million children (5.1%), of whom 13 million (0.7%) have a \"severe disability\"."},{"idx":4,"proposition":"In the coming years, disability will become an even greater concern due to the increase in its prevalence, which is explained by the aging of populations in particular.","correct":true,"justification":"TRUE\""}],"type":"custom"}
{"_id":"santepop-mpr-4","context":null,"enonce":"Regarding disability in France:","item":"santepop","matiere":"mpr","propositions":[{"idx":0,"proposition":"Disability in France affects about 1% of the population over a lifetime","correct":false,"justification":"According to the HS survey, among men or women, one in ten people report being severely limited for at least 6 months in daily activities because of a health problem"},{"idx":1,"proposition":"Up to 40 years, 5% of French people say they are severely limited","correct":true},{"idx":2,"proposition":"One in four people at age 75 report being severely limited in their daily activities","correct":true},{"idx":3,"proposition":"Nearly 40% of people living in ordinary homes report living with a physical, sensory, intellectual or mental disability","correct":true},{"idx":4,"proposition":"All impairments lead to disability sooner or later","correct":false,"justification":"However, not all impairments present a disability: only a minority leads to a limitation of activity.\""}],"type":"custom"}
{"_id":"santepop-mpr-7","context":null,"enonce":"Regarding impairment and disability in France:","item":"santepop","matiere":"mpr","propositions":[{"idx":0,"proposition":"7.9% of population reports urinary or faecal incontinence","correct":false,"justification":"0.79% of the population reports urinary or faecal incontinence"},{"idx":1,"proposition":"15% of the population reports difficulties leaving home alone","correct":false,"justification":"Regarding motor activities, 5% of the population report difficulties leaving home alone and 1.8% to go up or down a floor"},{"idx":2,"proposition":"Overall, the older people get, the more difficult it is to perform the simple activities of daily living.","correct":true},{"idx":3,"proposition":"The most frequently used technical aids are those used for movement (cane, chair, etc.)","correct":true},{"idx":4,"proposition":"Having a disabling disability leads to difficulties in participating in social life","correct":true,"justification":"TRUE\""}],"type":"custom"}
{"_id":"ECG-cardio-4","context":null,"enonce":"For complete branch blocks:","item":"ECG","matiere":"cardio","propositions":[{"idx":0,"proposition":"QRS are greater than 100ms","correct":false,"justification":"Between 100 and 120 ms, we are talking about incomplete BDBs."},{"idx":1,"proposition":"An rS or QS aspect in V1 signs a right branch block","correct":false,"justification":"BDB right: RsR' in V1"},{"idx":2,"proposition":"T waves are generally positive in D1 in case of left BDB","correct":false,"justification":"They are negative in D1, AVL, V5, V6"},{"idx":3,"proposition":"An elevation of the ST sergment in V1 V2 V3 in the presence of a BDB signs ischemia","correct":false,"justification":"They are normal. Most often they do not exceed 1 mm"},{"idx":4,"proposition":"An exclusive R aspect in V6 signs a left BDB","correct":true}],"type":"custom"}
{"_id":"tbmarchegeria-neuro-0","context":null,"enonce":"Regarding walking and balance disorders","item":"tbmarchegeria","matiere":"neuro","propositions":[{"idx":0,"proposition":"The gait of hemiplegic is described as the mowing gait, the patient is forced to describe an arc of a circle with internal concavity due to contracture and paralysis of the lower limb","correct":true},{"idx":1,"proposition":"Intermittent motor deficit on spinal cord claudication leads to fatigability of the lower limbs when walking, associated with pain","correct":false,"justification":"Intermittent motor deficit on spinal cord claudication leads to painless fatigability of the lower limbs associated with pyramidal syndrome in the lower limbs that must be sought after walking the patient"},{"idx":2,"proposition":"A symptomatology of the upper limbs must be investigated for cervico-osteoarthritis myelopathy","correct":true},{"idx":3,"proposition":"During pseudobulbar syndromes and lacunar conditions in the elderly, the gait is carried out in small steps, the foot sliding on the ground with each step with an automatic arm flapping abolished","correct":false,"justification":"During pseudobulbar syndromes and lacunar conditions in the elderly, the gait is carried out in small steps, the foot sliding on the ground with each step with an automatic arm fluttering preserved"},{"idx":4,"proposition":"Posterior cord involvement leads to a heeling gait","correct":true}],"type":"custom"}
{"_id":"tbmarchegeria-neuro-2","context":null,"enonce":"Regarding walking and balance disorders","item":"tbmarchegeria","matiere":"neuro","propositions":[{"idx":0,"proposition":"A parkinsonism must investigate iatrogenic causes, including taking neuroleptics or related","correct":true},{"idx":1,"proposition":"Astasie-abasia is defined as standing instability with spontaneous retropulsion (astasia) and inability to walk","correct":true},{"idx":2,"proposition":"A waddling approach related to proximal deficit must make research a neurological pathology as a priority","correct":false,"justification":"A waddling approach related to proximal deficiency must seek a muscular pathology (myopathy), including metabolic, inflammatory or iatrogenic, and also osteomalacia"},{"idx":3,"proposition":"Careful walking is often encountered in the elderly, a cautious approach related to anxiety that appeared following falls and can lead to a real stasobasophobia","correct":true},{"idx":4,"proposition":"Falling is a common accident in the elderly: 30% of those over sixty-five and 50% of those over eighty fall at least once a year.","correct":true}],"type":"custom"}
{"_id":"tbmarchegeria-neuro-3","context":null,"enonce":"Regarding walking and balance disorders","item":"tbmarchegeria","matiere":"neuro","propositions":[{"idx":0,"proposition":"After seventy years, falling is the leading cause of accidental death","correct":true},{"idx":1,"proposition":"Among the traumatic complications of falls, fractures of the lower end of the femur are the most common","correct":false,"justification":"Among the traumatic complications of falls, fractures of the upper extremity of the femur are the most common"},{"idx":2,"proposition":"Even in the absence of trauma, the inability of the older person to get up is a poor prognosis","correct":true},{"idx":3,"proposition":"Falling in the elderly is a severe traumatic event regardless of the extent of the consequences of the trauma","correct":true},{"idx":4,"proposition":"Post-fall syndrome occurs in about one-third of falls","correct":true}],"type":"custom"}
{"_id":"algiespelviennes-gyn-2","context":null,"enonce":"Regarding pelvic innervation:","item":"algiespelviennes","matiere":"gyn","propositions":[{"idx":0,"proposition":"The lower ureters are innervated by the pelvic plexus","correct":true},{"idx":1,"proposition":"The uterine body is innervated by the aortic plexus","correct":false,"justification":"Hypogastric plexus"},{"idx":2,"proposition":"The proximal third of the fallopian tubes is innervated by the hypogastric plexus","correct":true},{"idx":3,"proposition":"The wide ligament is innervated by the pelvic plexus","correct":true},{"idx":4,"proposition":"The ovaries are innervated by the hypogastric plexus","correct":false,"justification":"Aortic plexus"}],"type":"custom"}
{"_id":"antiinf-infectio-3","context":null,"enonce":"Regarding cephalosporins:","item":"antiinf","matiere":"infectio","propositions":[{"idx":0,"proposition":"They inhibit DNA elongation","correct":false,"justification":"Liaison to PLPs"},{"idx":1,"proposition":"They have the same mode of action as penicillins","correct":true},{"idx":2,"proposition":"Oral C3G has a bioavailability greater than 70%","correct":false,"justification":"Less than 50%. Digestive absorption is saturable"},{"idx":3,"proposition":"Elimination is biliary","correct":false,"justification":"Urinary elimination in active form. For ceftriaxone, there is also biliary elimination"},{"idx":4,"proposition":"The main side effect is skin allergy","correct":true}],"type":"custom"}
{"_id":"masseabdo-HGE-2","context":null,"enonce":"Regarding hepatomeaglia","item":"masseabdo","matiere":"HGE","propositions":[{"idx":0,"proposition":"In all cases, computed tomography and MRI should include a triphasic study after intravenous injection of vascular contrast medium (at arterial, portal and late times)","correct":true},{"idx":1,"proposition":"In case of dilation of the intrahepatic bile ducts, cholangio-MRI makes it possible to visualize the bile ducts and to specify the cause","correct":true},{"idx":2,"proposition":"Cardiac ultrasound should be done to clarify the cause of evoked cardiac involvement due to dilation of the hepatic veins and inferior vena cava.","correct":true},{"idx":3,"proposition":"Liver puncture-biopsy It is essential when the combination of clinical, laboratory and imaging data does not establish the cause of hepatomegaly","correct":true},{"idx":4,"proposition":"It should cover focal lesions and at a point in the rest of the parenchyma, in case of homogeneous hepatomegaly","correct":false,"justification":"It should cover focal lesions and at one point in the rest of the parenchyma, in case of heterogeneous hepatomegaly"}],"type":"custom"}
{"_id":"securitepro-mdt-1","context":null,"enonce":"Regarding post-professional follow-up:","item":"securitepro","matiere":"mdt","propositions":[{"idx":0,"proposition":"It is enshrined in legislation in France","correct":true},{"idx":1,"proposition":"It is always optional","correct":false,"justification":"It is mandatory following certain exhibitions"},{"idx":2,"proposition":"It is mandatory following exposure to asbestos","correct":true},{"idx":3,"proposition":"It allows the detection of acute pathologies with a short onset time","correct":false,"justification":"It will mainly intervene in the screening of chronic diseases with a long onset time"},{"idx":4,"proposition":"It is particularly useful for screening for occupational cancers ","correct":true}],"type":"custom"}
{"_id":"AVC-urg-9","context":null,"enonce":"Regarding lacunar infarctions:","item":"AVC","matiere":"urg","propositions":[{"idx":0,"proposition":"They can cause symmetric parkinsonism","correct":true,"justification":"By involvement of the basal ganglia (preferential involvement). Other preferential disorders are the posterior arm of the inner capsule and the foot of the bridge (or protuberance)"},{"idx":1,"proposition":"Lacunar infarctions are part of macroangiopathies","correct":false,"justification":"Microangiopathies (involvement of the small arteries)"},{"idx":2,"proposition":"Deficiencies are caused by occlusion of a superficial arteriole on lipohyalinosis (local arterial disease)","correct":false,"justification":"Occlusion of a deep arteriole"},{"idx":3,"proposition":"The main risk factor for lipohyalinosis is smoking","correct":false,"justification":"HTA is the first cause"},{"idx":4,"proposition":"The gaps are small infarcts more than 20 mm in diameter","correct":false}],"type":"custom"}
{"_id":"AVC-urg-12","context":null,"enonce":"Regarding MRI in stroke:","item":"AVC","matiere":"urg","propositions":[{"idx":0,"proposition":"A heart attack dating back less than 6 hours will be visible in sequence in broadcast.","correct":true,"justification":"Allows to visualize cerebral infarctions very early (a few minutes), in the form of systematized hyperintensity. It makes it possible to calculate the apparent diffusion coefficient (ADC) which is decreased (black) in case of cytotoxic edema."},{"idx":1,"proposition":"The T2 FLAIR allows you to view strokes older than 4h30 and older.","correct":true},{"idx":2,"proposition":"The diffusion sequences and T2 FLAIR may show a mismatch allowing an establishment of endovascular revascularization beyond the 6th hour.","correct":true},{"idx":3,"proposition":"The T2* sequence makes it possible to visualize any intraparenchymal ischemic lesion","correct":false,"justification":"T2* makes it possible to visualize fresh blood, so it allows to visualize an intraparenchymal hemorrhage"},{"idx":4,"proposition":"A FLAIR-diffusion mismatch reflects an ischemia probably dating from less than 4h30","correct":true}],"type":"custom"}
{"_id":"AVC-urg-14","context":null,"enonce":"Regarding acute stroke treatments:","item":"AVC","matiere":"urg","propositions":[{"idx":0,"proposition":"IV thrombolysis is beneficial when applied up to 6 hours after the onset of infarction","correct":false,"justification":"4:30 am"},{"idx":1,"proposition":"Thrombectomy is possible on distal thrombi","correct":false,"justification":"Only proximal thrombus. Mechanically speaking, it is impossible to reach distal thrombi."},{"idx":2,"proposition":"Mechanical thrombectomy is possible after 6 hours if there is clinical-radiological mismatch and\/or diffusion-perfusion mismatch","correct":true},{"idx":3,"proposition":"After thrombolysis, aspirin therapy should be initiated, in the absence of contraindications.","correct":true},{"idx":4,"proposition":"The patient must be initially positioned in the supine position with a straightening of the head at 30 °","correct":true}],"type":"custom"}
{"_id":"certificats-psy-4","context":null,"enonce":"On the principles of organ donation","item":"certificats","matiere":"psy","propositions":[{"idx":0,"proposition":"If the potential donor is a minor or an incapable adult, the consent of each of the holders of parental authority or legal representative is required","correct":true},{"idx":1,"proposition":"It is important to inform your loved ones of your decision regarding organ and tissue harvesting","correct":true},{"idx":2,"proposition":"The principle of non-patrimoniality of the body is enshrined in the law","correct":true},{"idx":3,"proposition":"Organ and tissue donation is free of charge and cannot be marketed, unless agreed at the discretion of both parties.","correct":false,"justification":"As a result, organ and tissue donation is free of charge and cannot be marketed."},{"idx":4,"proposition":"The Civil Code and the Public Health Code define the rule of anonymity that applies to all donations on deceased donors but not to living donors","correct":true,"justification":"TRUE\""}],"type":"custom"}
{"_id":"certificats-psy-6","context":null,"enonce":"Regarding the epidemiology and EME of organ donation","item":"certificats","matiere":"psy","propositions":[{"idx":0,"proposition":"The purpose of anonymity is to limit any pressure or conflict of interest on the potential donor or recipient restricting his or her free consent.","correct":true},{"idx":1,"proposition":"The Public Health Code prohibits \"advertising for organ donation for the benefit of a specific person or for the benefit of a specific institution or organization\"","correct":true},{"idx":2,"proposition":"Currently, 1,500,000 people die each year in France","correct":false,"justification":"Definition and etiologies Currently, 500,000 people die per year in France of which about 4,000 (0.85%) in EM in an intensive care facility"},{"idx":3,"proposition":"The state of brain death (EME) results from the \"irreversible and isolated destruction of all intracranial nerve centers (cortex and brainstem) following complete brain circulatory arrest\"","correct":true},{"idx":4,"proposition":"Brain destruction suppresses central respiration control, as well as regulation of circulatory, thermal, and endocrine homeostasis","correct":true,"justification":"TRUE\""}],"type":"custom"}
{"_id":"ProtU-nephro-0","context":null,"enonce":"Regarding the basics of renal physiology:","item":"ProtU","matiere":"nephro","propositions":[{"idx":0,"proposition":"The proximal tubule reabsorbs the vast majority of physiologically filtered proteins","correct":true},{"idx":1,"proposition":"In the normal state, only proteins below 600 kD are filtered","correct":false,"justification":"Less than 70 kD"},{"idx":2,"proposition":"Kappa light chains are not freely filtered in the physiological state","correct":false,"justification":"They are low molecular weight so yes"},{"idx":3,"proposition":"Under physiological conditions, the amount of albumin present in the urine is less than 15-30 mg\/d","correct":true,"justification":"See item in the latest edition (8°) of the college p.115"},{"idx":4,"proposition":"Urinary creatinine excretion in an adult is approximately 1 g\/d","correct":true}],"type":"custom"}
{"_id":"ProtU-nephro-1","context":null,"enonce":"Which propositions are true?","item":"ProtU","matiere":"nephro","propositions":[{"idx":0,"proposition":"Abundant hematuria may interfere with the interpretation of proteinuria on BU","correct":true},{"idx":1,"proposition":"Microscopic hematuria causes abundant proteinuria due to hemolysis of RBCs","correct":false,"justification":"This is the case of macroscopic hematuria only"},{"idx":2,"proposition":"ECBU enables qualitative study of proteinuria","correct":false,"justification":"This is the case of urinary protein electrophoresis"},{"idx":3,"proposition":"Glomerular proteinuria is said to be selective if it consists of more than 80% albumin","correct":true},{"idx":4,"proposition":"Tubular proteinurias are a sign of proximal tubular reabsorption disorder","correct":true}],"type":"custom"}
{"_id":"handicapped-mpr-2","context":null,"enonce":"Concerning the management of disability in children:","item":"handicapped","matiere":"mpr","propositions":[{"idx":0,"proposition":"The child's project is exclusively therapeutic and medical","correct":false,"justification":"The child's project is threefold: therapeutic (medical, paramedical...), educational (schooling), social (family, life activities, environment, home care, compensation...)"},{"idx":1,"proposition":"We must detect the causes of over-disability","correct":true},{"idx":2,"proposition":"The therapeutic objective will be to manage the pain and the medical consequences of the disability","correct":false,"justification":"The therapeutic objective is to prevent or treat these so-called neuro-orthopedic disorders"},{"idx":3,"proposition":"The schooling to be considered in the first place is ordinary schooling","correct":true},{"idx":4,"proposition":"The long-term goal is to bring the child into adulthood towards a completely normal life project.","correct":false,"justification":"The long-term goal is to bring the child into adulthood towards a personalized project of independent living in an optimal medical-surgical, cognitive and psychic situation."}],"type":"custom"}
{"_id":"dyspnee-pneumo-6","context":null,"enonce":"Regarding scales:","item":"dyspnee","matiere":"pneumo","propositions":[{"idx":0,"proposition":"The Borg scale quantifies dyspnea in acute situations","correct":true},{"idx":1,"proposition":"The Borg scale is between 0 and 4","correct":false,"justification":"This is the case for the MRC. The Borg scale is a subjective verbal scale between 0 and 10"},{"idx":2,"proposition":"The scale for chronic dyspnea is modified CKD","correct":true},{"idx":3,"proposition":"Stage 0 indicates a total absence of dyspnea","correct":false,"justification":"Shortness of breath only for significant effort"},{"idx":4,"proposition":"Stage 3 CKD refers to shortness of breath at rest","correct":false,"justification":"After a few minutes of walking flat"}],"type":"custom"}
{"_id":"palu-infectio-12","context":null,"enonce":"Which of the following are criteria for hospitalization in a patient with malaria? (DO NOT check the severity criteria if you see 🤭🙈 any)","item":"palu","matiere":"infectio","propositions":[{"idx":0,"proposition":"Vomiting.","correct":true,"justification":"True\r\nIt is a digestive disorder that makes oral treatment impossible."},{"idx":1,"proposition":"Parasitemia>4%.","correct":false,"justification":"False. Parasitemia > 2%. Be careful not to confuse hospitalization criteria with severity criteria."},{"idx":2,"proposition":"Creatinemia>265 μmol\/l.","correct":false,"justification":"False. Creatinemia>150 μmol\/l. Be careful not to confuse hospitalization criteria with severity criteria."},{"idx":3,"proposition":"Haemoglobinaemia < 10 g\/dl","correct":true,"justification":"True."},{"idx":4,"proposition":"Splenectomized patient. ","correct":true}],"type":"custom"}
{"_id":"suivinourisson-ophtalmo-0","context":null,"enonce":"General:","item":"suivinourisson","matiere":"ophtalmo","propositions":[{"idx":0,"proposition":"15-20% of children under 6 years of age have a visual abnormality","correct":true},{"idx":1,"proposition":"Cataract screening is optimal in the first 3 years of life","correct":false,"justification":"Optimal before the age of 2 months"},{"idx":2,"proposition":"The most common visual deficits are severe deficits such as congenital cataracts.","correct":false,"justification":"These are minor\/moderate deficits that include ametropia or refractive disorders"},{"idx":3,"proposition":"Strabismus is a severe visual deficit","correct":false,"justification":"Classified as minor\/moderate"},{"idx":4,"proposition":"Hyperopitia is a minor or moderate visual deficit","correct":true,"justification":"Minor\/moderate difference following the internship"}],"type":"custom"}
{"_id":"oreillons-infectio-1","context":null,"enonce":"About mumps","item":"oreillons","matiere":"infectio","propositions":[{"idx":0,"proposition":"Vaccination coverage in France is still insufficient to hope for eradication","correct":true},{"idx":1,"proposition":"Diagnosis is essentially clinical","correct":true},{"idx":2,"proposition":"State phase: mumps parotitis in 70% of cases","correct":true},{"idx":3,"proposition":"In case of parotitis, turgor of the orifice of the santorini canal is found on examination","correct":false,"justification":"There is turgidity of the orifice of the Steno canal"},{"idx":4,"proposition":"The steno canal plugs at the level of the upper 2nd molar on the left and at","correct":true}],"type":"custom"}
{"_id":"accouchementN-gyn-4","context":null,"enonce":"Which of these proposals correspond to real fetal dimensions?","item":"accouchementN","matiere":"gyn","propositions":[{"idx":0,"proposition":"Biiliac: 18 cm","correct":false,"justification":"8 cm"},{"idx":1,"proposition":"Sternodorsal: 3 cm","correct":false,"justification":"9.5 cm"},{"idx":2,"proposition":"Sacropubic : 7.5 cm","correct":true},{"idx":3,"proposition":"Bi-trochanterian: 12 cm","correct":false,"justification":"9 cm"},{"idx":4,"proposition":"Bi-acromial: 12 cm (reducible by compaction)","correct":true,"justification":"Passes to 9.5 cm after settlement\""}],"type":"custom"}
{"_id":"Kcvessie-onco-4","context":null,"enonce":"Regarding histology:","item":"Kcvessie","matiere":"onco","propositions":[{"idx":0,"proposition":"The most common carcinomas are squamous cell carcinomas","correct":false,"justification":"Urothelial carcinomas most often (in 90% of cases)"},{"idx":1,"proposition":"Tumors infiltrating the muscularis are the most frequent and serious","correct":false,"justification":"They are associated with the poorest prognosis (5-year survival is less than 50%) but they represent only 20% of urothelial carcinomas. 80% of them do not infiltrate the muscularla"},{"idx":2,"proposition":"Tumours that do not infiltrate the muscularis are below T2","correct":true,"justification":"See diagram in the Medline"},{"idx":3,"proposition":"Non-muscular-infiltrating tumours are all low-grade","correct":false,"justification":"Low or high grade"},{"idx":4,"proposition":"The tumors infiltrating the muscularis are all high grade","correct":true}],"type":"custom"}
{"_id":"Kcvessie-onco-5","context":null,"enonce":"Which of these proposals can cause a bladder tumor?","item":"Kcvessie","matiere":"onco","propositions":[{"idx":0,"proposition":"Prostatic radiotherapy, in less than two years","correct":false,"justification":"After 5 years"},{"idx":1,"proposition":"Pelvic radiation therapy after five years","correct":true},{"idx":2,"proposition":"NSAIDs ","correct":false,"justification":"Not mentioned in the medline"},{"idx":3,"proposition":"Prolonged cyclophosphamides","correct":true},{"idx":4,"proposition":"Platinum salts","correct":false,"justification":"Not mentioned in the medline. They are used as a treatment in chemotherapy"}],"type":"custom"}
{"_id":"Kcvessie-onco-6","context":null,"enonce":"Which of the following are true?","item":"Kcvessie","matiere":"onco","propositions":[{"idx":0,"proposition":"Urothelium disease can affect synchronously or metachrone calyxes, pelvis, ureters, bladder and urethra","correct":true},{"idx":1,"proposition":"The bladder is affected preferentially due to the large surface area of the urothelium and the prolonged contact time with urinary carcinogens ","correct":true,"justification":"True. Like tobacco residues, for example,"},{"idx":2,"proposition":"Macroscopic hematuria is very rare in NITV","correct":false,"justification":"Macroscopic hematuria is present in the vast majority of cases"},{"idx":3,"proposition":"Any macroscopic hematuria should look for a bladder tumor","correct":true},{"idx":4,"proposition":"Any suspicion of bladder tumours should be investigated for risk factors at the interview.","correct":true}],"type":"custom"}
{"_id":"MTEV-cardio-1","context":null,"enonce":"About venous thromboembolic disease (VTE)","item":"MTEV","matiere":"cardio","propositions":[{"idx":0,"proposition":"Travel >5-6 hours is a major transient risk factor for VTE","correct":false,"justification":"Minor transient"},{"idx":1,"proposition":"Bed rest of more than 3 days is a major transient risk factor for VTE if it occurred less than 3 months ago","correct":true},{"idx":2,"proposition":"PE is fatal within the first hour in 10% of cases","correct":true},{"idx":3,"proposition":"A thrombosis of the inferior or superior vena cava must imperatively search for neoplasia","correct":true},{"idx":4,"proposition":"The risk of postoperative VTE is particularly high during the two weeks postoperatively, but remains high for two to three years","correct":false,"justification":"It stays high for two to three months"}],"type":"custom"}
{"_id":"MTEV-cardio-5","context":null,"enonce":"Which of these proposals fall within the scope of calculating Wells' score?","item":"MTEV","matiere":"cardio","propositions":[{"idx":0,"proposition":"Increasing the volume of the calf","correct":true},{"idx":1,"proposition":"Pain","correct":true},{"idx":2,"proposition":"Immobilization","correct":true},{"idx":3,"proposition":"The presence of hemoptysis","correct":false,"justification":"Wells' score is DVT (Deep Vein Thrombosis). This is the Geneva score, which concerns PE (Pulmonary Embolism), which contains hemoptysis, among others."},{"idx":4,"proposition":"Age","correct":false,"justification":"The Wells score contains: neoplasia, immobilization, pain, enlarged edema, and history."}],"type":"custom"}
{"_id":"psychotropes-psy-6","context":null,"enonce":"Which propositions are true?","item":"psychotropes","matiere":"psy","propositions":[{"idx":0,"proposition":"Second-generation antipsychotics are specific to D2 recipients","correct":false,"justification":"They also act at the level of serotonergic receptors"},{"idx":1,"proposition":"Serotoningergic syndrome is linked to the clozapine user","correct":false,"justification":"Clozapine is a first-generation antipsychotic (with many side effects, including agranulocytosis). Serotonin syndrome is observed when using an antidepressant"},{"idx":2,"proposition":"Venlafaxine is an SSRI","correct":false,"justification":"It is an ISRSNA"},{"idx":3,"proposition":"Hypnotics are potentiators of GABA","correct":true,"justification":"Their use is not recommended in minors"},{"idx":4,"proposition":"Modafinil is indicated for narcolepsy","correct":true,"justification":"It is a relatively effective psychostimulant treatment in this indication"}],"type":"custom"}
{"_id":"psychotropes-psy-7","context":null,"enonce":"What are the contraindications of MAOIs?","item":"psychotropes","matiere":"psy","propositions":[{"idx":0,"proposition":"History of stroke","correct":true},{"idx":1,"proposition":"Pheochromocytoma","correct":true},{"idx":2,"proposition":"Addison's disease","correct":false},{"idx":3,"proposition":"Parkinson's disease","correct":false},{"idx":4,"proposition":"Pregnancy","correct":true,"justification":"As well as breastfeeding"}],"type":"custom"}
{"_id":"psychotropes-psy-11","context":null,"enonce":"Which of the following are contraindications (CIs) for benzodiazepines?","item":"psychotropes","matiere":"psy","propositions":[{"idx":0,"proposition":"Sleep Apnea Syndrome not fitted","correct":true},{"idx":1,"proposition":"Myasthenia","correct":true,"justification":"True in front of the muscle relaxant property of benzodiazepines 💪"},{"idx":2,"proposition":"History of epilespia","correct":false,"justification":"The 6 effects of benzodiazepines: anxiolytics, sedatives, muscle relaxants, anticonvulsants, amnesiacs, orexigens"},{"idx":3,"proposition":"Severe hepatic impairment","correct":true,"justification":"True. Benzodiazepines are metabolized in the liver (source: https:\/\/pharmacomedicale.org\/medicaments\/par-specialites\/item\/benzodiazepines)"},{"idx":4,"proposition":"Stented myocardial infarction","correct":false,"justification":"Not an IC"}],"type":"custom"}
{"_id":"parkinson-neuro-9","context":null,"enonce":"Which of the following are true?","item":"parkinson","matiere":"neuro","propositions":[{"idx":0,"proposition":"Neuronal loss mainly concerns the caudate nucleus","correct":false,"justification":"Especially the nigro-striatal pathway (and in particular the substantia nigra pars compacta, located in the midbrain), with the presence of Lewy bodies (alpha-synuclein)"},{"idx":1,"proposition":"Neuronal loss is inexorable in view of the current state of knowledge","correct":true},{"idx":2,"proposition":"Alzheimer's disease, Huntington's disease and Guillain-Barré syndrome are neurodegenerative diseases","correct":false,"justification":"Guillain-Barré syndrome (acute inflammatory polyradiculoneuritis) is not a neurodegenerative disease but an inflammatory disease, as its real name suggests."},{"idx":3,"proposition":"Neuroprotective treatment would slow neuronal loss","correct":true},{"idx":4,"proposition":"Anatomical pathology visualizes senile plaques","correct":false,"justification":"Anatomical pathology visualizes intracytoplasmic Lewy bodies composed of alpha-synuclein"}],"type":"custom"}
{"_id":"droits-sp-5","context":null,"enonce":"Concerning the person(s) bound by medical confidentiality ","item":"droits","matiere":"sp","propositions":[{"idx":0,"proposition":"Medical confidentiality concerns only doctors, by definition","correct":false,"justification":"Medical and paramedical personnel Secrecy concerns any person who, in his state or profession, or because of a temporary function or mission, has received information to which the law accords secrecy."},{"idx":1,"proposition":"Medical confidentiality concerns medical and paramedical staff only","correct":false,"justification":"Nevertheless, they are not the only ones, because all the staff of a health structure are bound by this secret, which is then collective within a team."},{"idx":2,"proposition":"Hospital volunteers are not subject to medical confidentiality","correct":false,"justification":"non-nursing staff The rule of secrecy also applies to staff who are not in contact with patients, but who are also likely to have secret information such as, for example, secretaries, administrative and technical staff, hospital staff, student researchers or hospital volunteers."},{"idx":3,"proposition":"The occupational physician shares medical information with the employer","correct":false,"justification":"The occupational physician does not share secrecy with the employer"},{"idx":4,"proposition":"The occupational physician does not directly share the secrecy with the health professionals involved in the care","correct":true,"justification":"TRUE\""}],"type":"custom"}
{"_id":"infnasosin-infectio-3","context":null,"enonce":"Which of the following proposals are among the major criteria for diagnosing acute maxillary sinusitis?","item":"infnasosin","matiere":"infectio","propositions":[{"idx":0,"proposition":"Unilateral pain and pulsalite, vesper and increasing head tilted forward","correct":true,"justification":"True. There are 3 major criteria. At least 2 of the 3 criteria are needed to diagnose acute maxillary sinusitis. \r\n1. Persistence or even increase of suborbital sinus pain despite symptomatic treatment (analgesic, antipyretic, decongestant) taken for at least 48 hours;\r\n2. Type of pain: unilateral and pulsatile nature of the pain, or its increase when the head is tilted forward, or its acme at the end of the day or at night;\r\n3. Increased rhinorrhea and increased purulence of rhinorrhea; This sign has all the more value as it becomes unilateral."},{"idx":1,"proposition":"Increased rhinorrhea and increased purulence of rhinorrhea","correct":true},{"idx":2,"proposition":"Suborbital pain evolving for 48 hours resistant to symptomatic treatments","correct":true},{"idx":3,"proposition":"Persistence of fever > 72h","correct":false,"justification":"False. This is a minor criterion."},{"idx":4,"proposition":"Unilateral nasal obstruction","correct":false,"justification":"False. This is a minor criterion."}],"type":"custom"}
{"_id":"infnasosin-infectio-6","context":null,"enonce":"Among the following proposals, which are the 2 bacteria most often responsible for bacterial sinusitis?","item":"infnasosin","matiere":"infectio","propositions":[{"idx":0,"proposition":"Streptococcus pneumoniae","correct":true},{"idx":1,"proposition":"Haemophilius influenzae","correct":true},{"idx":2,"proposition":"Streptococcus viridans","correct":false,"justification":"Commensal germ"},{"idx":3,"proposition":"Pseudomonas aeruginosa","correct":false,"justification":"Very rare"},{"idx":4,"proposition":"Staphylococcus aureus","correct":false,"justification":"Very rare"}],"type":"custom"}
{"_id":"systemesoins-sp-9","context":null,"enonce":"Which of these propositions are true?","item":"systemesoins","matiere":"sp","propositions":[{"idx":0,"proposition":"The establishment of health alerts and crises is one of the objectives of health policies","correct":false,"justification":"Preparedness and anticipation of health disasters (not their development, of course)"},{"idx":1,"proposition":"The promotion of training, research and innovation activities in the field of health is one of the objectives of health policy","correct":true},{"idx":2,"proposition":"Parliament gives its opinion on funding but has no real power vis-à-vis the Ministry of Health","correct":false,"justification":"It votes on laws related to health and the organization of the system and therefore has a power of direct validation."},{"idx":3,"proposition":"The LFSS is voted by a committee bringing together the HAS, the Order of Physicians, the ANSM and the ARS","correct":false,"justification":"Since 1996, Parliament has voted each year a Social Security Financing Law (LFSS): It sets an objective (ONDAM: National Expenditure Target Forecast Expenditure for the following year of Social Health Insurance Sickness)"},{"idx":4,"proposition":"The Social Security Directorate implements social security policy","correct":true,"justification":"TRUE\""}],"type":"custom"}
{"_id":"contraception-endoc-1357c4","context":null,"enonce":"Which of the following is\/are true?","item":"contraception","matiere":"endoc","propositions":[{"correct":false,"justification":"False. 72h. This is levonorgestrel. ","idx":0,"proposition":"A 2nd generation progesterone can be used as emergency contraception within 96 hours of sexual intercourse"},{"correct":true,"justification":"Contrary to what can be found in some sources, ulipristal is available without a prescription according to this HAS sheet (updated in 2019): https:\/\/webzine.has-sante.fr\/upload\/docs\/application\/pdf\/2015-07\/contraception_urgence_officine_maj_juillet2015.pdf If it is no longer valid, do not hesitate to notify us by reporting the IQ:)","idx":1,"proposition":"Acetate ulipristal is available without a prescription in pharmacies for emergency contraception"},{"correct":true,"justification":"True","idx":2,"proposition":"The copper IUD is an emergency contraception that can be used within 5 days of sexual intercourse"},{"correct":true,"justification":"True","idx":3,"proposition":"Contraindications of acetate ulipristal are severe asthma and severe hepatic impairment"},{"correct":true,"justification":"True","idx":4,"proposition":"Emergency contraception in pharmacies is free and anonymous for minors"}],"type":"custom"}
{"_id":"nutrigrossesse-endoc-159045","context":null,"enonce":"Which of the following are true?","item":"nutrigrossesse","matiere":"endoc","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"The energy \"cost\" of pregnancy is on average 150 kcal\/d in the 1st trimester"},{"correct":false,"justification":"150 kcal\/d in Q1","idx":1,"proposition":"The energy \"cost\" of pregnancy is on average 250 kcal\/d in the 1st trimester"},{"correct":false,"justification":"350 kcal\/d in the second and third trimesters","idx":2,"proposition":"The energy \"cost\" of pregnancy is on average 250 kcal\/d in the 2nd trimester"},{"correct":true,"justification":"True","idx":3,"proposition":"The energy \"cost\" of pregnancy is on average 350 kcal\/d in the 2nd trimester"},{"correct":false,"justification":"350 kcal\/d in the second and third trimesters","idx":4,"proposition":"The energy \"cost\" of pregnancy is on average 450 kcal\/d in the 3rd trimester"}],"type":"custom"}
{"_id":"tbrefraction-ophtalmo-20ff05","context":null,"enonce":"Which of the following corresponds to a normal reading of the largest letters on the Parinaud scale?","item":"tbrefraction","matiere":"ophtalmo","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"P25"},{"correct":false,"justification":"False","idx":1,"proposition":"P32"},{"correct":false,"justification":"False","idx":2,"proposition":"P12"},{"correct":true,"justification":"True","idx":3,"proposition":"P14"},{"correct":false,"justification":"False","idx":4,"proposition":"P5"}],"type":"custom"}
{"_id":"AV--ophtalmo-262e69","context":null,"enonce":"Which of the following are treatments for exudative AMD?","item":"AV-","matiere":"ophtalmo","propositions":[{"correct":false,"justification":"Part of the package for beginner AMD","idx":0,"proposition":"Vitamin e"},{"correct":true,"justification":"True","idx":1,"proposition":"Dynamic phototherapy"},{"correct":true,"justification":"True","idx":2,"proposition":"Anti-VEGF"},{"correct":false,"justification":"Exact for the atrophic form","idx":3,"proposition":"No therapeutics currently"},{"correct":false,"justification":"Part of the package for beginner AMD","idx":4,"proposition":"Zinc"}],"type":"custom"}
{"_id":"diplopie-ophtalmo-285235","context":null,"enonce":"Which of the following propositions are true for oculomotor nerve paralysis?","item":"diplopie","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True, says << providential ptosis>> ","idx":0,"proposition":"Total ptosis is observed"},{"correct":false,"justification":"Divergence","idx":1,"proposition":"There is a marked convergence"},{"correct":true,"justification":"True","idx":2,"proposition":"Elevation of the eye is not possible"},{"correct":false,"justification":"Areflective mydriasis","idx":3,"proposition":"An areflective myosis is observed"},{"correct":true,"justification":"True","idx":4,"proposition":"There is a loss of accommodation"}],"type":"custom"}
{"_id":"tbvisionbrutal-ophtalmo-3e2fe9","context":null,"enonce":"Among the following proposals, what are the two main causes of myodesopsia?","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"correct":false,"justification":"Not a cause of myodesopsias","idx":0,"proposition":"OACR"},{"correct":false,"justification":"Not the most common","idx":1,"proposition":"Hyalite"},{"correct":true,"justification":"True","idx":2,"proposition":"Retinal detachment"},{"correct":false,"justification":"Not the most common","idx":3,"proposition":"Posterior vitreous detachment"},{"correct":true,"justification":"True, like Roberto in Olive and Tom","idx":4,"proposition":"Retinal tear"}],"type":"custom"}
{"_id":"diplopie-ophtalmo-4cee8f","context":null,"enonce":"Which of the following propositions are true regarding nerve paralysis VI abducens?","item":"diplopie","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"The nerve innervates the lateral right"},{"correct":true,"justification":"True","idx":1,"proposition":"There is a convergence of the affected eye"},{"correct":false,"justification":"Abduction deficit","idx":2,"proposition":"There is a deficit in the supply of"},{"correct":false,"justification":"On the paralyzed side","idx":3,"proposition":"The head, to compensate, turns to the healthy side"},{"correct":false,"justification":"Horizontal","idx":4,"proposition":"Diplopia is vertical"}],"type":"custom"}
{"_id":"vaccin-infectio-5082f2","context":null,"enonce":"What vaccinations are mandatory at 4 months?","item":"vaccin","matiere":"infectio","propositions":[{"correct":false,"justification":"M12 then M16-M18","idx":0,"proposition":"MMR"},{"correct":false,"justification":"The mandatory vaccine is against meningococcal C and it is at M5 and M12","idx":1,"proposition":"Meningococcal B"},{"correct":true,"justification":"True","idx":2,"proposition":"Dtp"},{"correct":true,"justification":"True","idx":3,"proposition":"Acellular whooping cough"},{"correct":false,"justification":"Hepatitis B, no hepatitis C vaccine ","idx":4,"proposition":"Hepatitis C"}],"type":"custom"}
{"_id":"tbvisionbrutal-ophtalmo-60e965","context":null,"enonce":"By what is the anterior chamber, rear, delimited?","item":"tbvisionbrutal","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True. The aqueous humor fills the anterior chamber, bounded by \r\nthe cornea in front and the iris in the back","idx":0,"proposition":"Iris"},{"correct":false,"justification":"Forward","idx":1,"proposition":"Cornea"},{"correct":false,"justification":"False","idx":2,"proposition":"Crystalline"},{"correct":false,"justification":"False","idx":3,"proposition":"Choroid"},{"correct":false,"justification":"False","idx":4,"proposition":"Zonum"}],"type":"custom"}
{"_id":"suiviMIT-infectio-67770d","context":null,"enonce":"Among the following diseases, for which school eviction is mandatory?","item":"suiviMIT","matiere":"infectio","propositions":[{"correct":true,"justification":"True, for bacilliferous people. Direct scrutiny must have been negativized ","idx":0,"proposition":"Tuberculosis"},{"correct":true,"justification":"True, up to 3 days after local treatment  ","idx":1,"proposition":"Scabies"},{"correct":false,"justification":"No malaria is vector-borne 🦟, and does not require school eviction ","idx":2,"proposition":"Malaria"},{"correct":true,"justification":"True ","idx":3,"proposition":"Measles"},{"correct":false,"justification":"No, among the MMR vaccine targets, ONLY measles is mandatory eviction. However, since 2018, measles AND rubella are notifiable. ","idx":4,"proposition":"Rubella "}],"type":"custom"}
{"_id":"ACR-urg-6c660a","context":null,"enonce":"Which of the following proposals about chest compressions are true?","item":"ACR","matiere":"urg","propositions":[{"correct":false,"justification":"Scythe, 5-6 cm","idx":0,"proposition":"It is necessary to apply a depression of 10-12 cm by pressing on the sternum, arms outstretched"},{"correct":true,"justification":"True","idx":1,"proposition":"The pace is 100 to 120 compressions per minute"},{"correct":true,"justification":"True, compressions are ineffective after 2 minutes, while the feeling of fatigue occurs only 2 to 3 minutes later","idx":2,"proposition":"Ideally you have to take turns between rescuers every two minutes"},{"correct":false,"justification":"On the back","idx":3,"proposition":"The patient should lie on his stomach and on a hard plane"},{"correct":false,"justification":"False, the duration of relaxation and compression must be the same to allow a good chest reexpansion and therefore allow the heart to fill before recompressing. ","idx":4,"proposition":"The compression time must be greater than the release time that occurs after each compression"}],"type":"custom"}
{"_id":"prurit-dermato-85dbef","context":null,"enonce":"Which of the following are causes of pruritus sine materia?","item":"prurit","matiere":"dermato","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Lymphoma"},{"correct":true,"justification":"True","idx":1,"proposition":"Pregnancy"},{"correct":true,"justification":"True","idx":2,"proposition":"Hepatic cholestasis"},{"correct":true,"justification":"True","idx":3,"proposition":"Chronic renal failure"},{"correct":true,"justification":"True","idx":4,"proposition":"All propositions are true"}],"type":"custom"}
{"_id":"infdermato-dermato-86bcfa","context":null,"enonce":"Which of the following propositions are true about mycotic vulvovaginitis due to Candida?","item":"infdermato","matiere":"dermato","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"They are due to Candida albicans"},{"correct":true,"justification":"True","idx":1,"proposition":"They are itchy"},{"correct":false,"justification":"In fact, it is excessive hygiene that is a risk factor, along with immunosuppression. ","idx":2,"proposition":"They are due to poor hygiene"},{"correct":false,"justification":"It is possible, but Candida is present in the mucous membranes in the saprophytic state","idx":3,"proposition":"This is an STI"},{"correct":false,"justification":"Alkaline hygiene and local antifungal treatment","idx":4,"proposition":"It is treated with general antibiotic therapy"}],"type":"custom"}
{"_id":"ascite-HGE-87149e","context":null,"enonce":"Which of the following are etiologies of exudative ascites?","item":"ascite","matiere":"HGE","propositions":[{"correct":false,"justification":"Transudate","idx":0,"proposition":"Hypoalbuminemia"},{"correct":false,"justification":"Transudate","idx":1,"proposition":"Cirrhosis"},{"correct":true,"justification":"True","idx":2,"proposition":"Peritoneal mesothelioma"},{"correct":true,"justification":"True","idx":3,"proposition":"Peritoneal carcinomatosis"},{"correct":true,"justification":"True","idx":4,"proposition":"Syndrome de Budd-Chiari"}],"type":"custom"}
{"_id":"prurit-dermato-9b0edd","context":null,"enonce":"Which of the following proposals are part of the first-line biological assessment in case of pruritus sine materia?","item":"prurit","matiere":"dermato","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"NFS-P"},{"correct":true,"justification":"True","idx":1,"proposition":"Gamma-GT and PAL"},{"correct":false,"justification":"Useless","idx":2,"proposition":"Corrected serum calcium"},{"correct":false,"justification":"Useless","idx":3,"proposition":"Magnessemia"},{"correct":false,"justification":"Useless","idx":4,"proposition":"TGO TGP"}],"type":"custom"}
{"_id":"pathoOGE-endoc-b53293","context":null,"enonce":"Which of the following propositions are true regarding torsion of the spermatic cord?","item":"pathoOGE","matiere":"endoc","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Surgical exploration within six hours"},{"correct":true,"justification":"True","idx":1,"proposition":"Severe pain"},{"correct":false,"justification":"Abolished on the side of the lesion","idx":2,"proposition":"Bilateral cremasterial reflex"},{"correct":true,"justification":"True","idx":3,"proposition":"Ascended testicle"},{"correct":false,"justification":"✖","idx":4,"proposition":"All propositions are true"}],"type":"custom"}
{"_id":"antiinf-infectio-bddeb8","context":null,"enonce":"Which of the following are true about vancomycin?","item":"antiinf","matiere":"infectio","propositions":[{"correct":false,"justification":"Glycopeptide","idx":0,"proposition":"It is a macrolide"},{"correct":true,"justification":"True, slow bactericidal","idx":1,"proposition":"It is a bactericide"},{"correct":true,"justification":"True","idx":2,"proposition":"It's a time-dependent"},{"correct":false,"justification":"Nonexistent. Always by IV except for the treatment of Clostridium","idx":3,"proposition":"Digestive absorption is total"},{"correct":true,"justification":"True","idx":4,"proposition":"Vancomycin is ineffective on gram bacillus -"}],"type":"custom"}
{"_id":"herpes-infectio-cd0909","context":null,"enonce":"For which virus(ies), belonging to the Herpesvirus family, is there a vaccine?","item":"herpes","matiere":"infectio","propositions":[{"correct":false,"justification":"A vaccine seems to be in development at the moment, however.","idx":0,"proposition":"HSV-1"},{"correct":false,"justification":"Vaccines are currently only available for VZV infection","idx":1,"proposition":"EBV"},{"correct":false,"justification":"","idx":2,"proposition":"CMV"},{"correct":false,"justification":"It does not belong to the herpesviridae family","idx":3,"proposition":"HBV"},{"correct":true,"justification":"Yes ","idx":4,"proposition":"VZV "}],"type":"custom"}
{"_id":"AV--ophtalmo-d50bbf","context":null,"enonce":"What is the normal intraocular pressure threshold in mmHg?","item":"AV-","matiere":"ophtalmo","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"15"},{"correct":true,"justification":"True. Normal value: less than or equal to 22 mmHg","idx":1,"proposition":"22"},{"correct":false,"justification":"False","idx":2,"proposition":"36"},{"correct":false,"justification":"False","idx":3,"proposition":"45"},{"correct":false,"justification":"False","idx":4,"proposition":"58"}],"type":"custom"}
{"_id":"puberte-gyn-e02c06","context":null,"enonce":"Which of the following are true?","item":"puberte","matiere":"gyn","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Central precocious puberty is more common in girls than in boys."},{"correct":true,"justification":"True","idx":1,"proposition":"Central early puberty is due to premature reactivation (lesional or not) of the hypothalamic-pituitary-gonadal axis."},{"correct":true,"justification":"True. Always think about intracranial expansive processes in the causes of precocious puberty especially in boys.","idx":2,"proposition":"Chiasma glioma can cause early puberty"},{"correct":false,"justification":"False. McCune Albright syndrome can lead to peripheral precocious puberty.                              McCune-Albright syndrome is a rare sporadic disease, defined by the triad: coffee-au-lait spots, fibrous dysplasia of the bones and endocrinopathy. The diagnosis is often made on bone or endocrine involvement, but must be suspected on the particular morphology of coffee-au-lait spots","idx":3,"proposition":"McCune Albright syndrome can lead to central precocious puberty."},{"correct":true,"justification":"True. Very important to look for skin signs in favor of NF1 (which can give gliomas and therefore central precocious puberty) and McCune Albright syndrome","idx":4,"proposition":"A complete skin examination of the child coming for suspected early puberty is essential."}],"type":"custom"}
{"_id":"Kcos-onco-e20969","context":null,"enonce":"Which of the following are benign tumors?","item":"Kcos","matiere":"onco","propositions":[{"correct":false,"justification":"Malignant tumour (mainly affecting the diaphysis)","idx":0,"proposition":"Ewing sarcoma "},{"correct":true,"justification":"True","idx":1,"proposition":"Osteochondroma "},{"correct":false,"justification":"Malignant tumour (mainly affecting the metaphysis in the knee)","idx":2,"proposition":"Osteosarcoma "},{"correct":true,"justification":"True","idx":3,"proposition":"Osteoid osteoma "},{"correct":false,"justification":"Malignancy","idx":4,"proposition":"Solitary plasmacytoma "}],"type":"custom"}
{"_id":"glaucomechr-ophtalmo-e34bfd","context":null,"enonce":"Which of the following propositions are true about CAPG?","item":"glaucomechr","matiere":"ophtalmo","propositions":[{"correct":false,"justification":"Visible","idx":0,"proposition":"The trabeculum is not visible in gonioscopy"},{"correct":false,"justification":"Open, by definition","idx":1,"proposition":"The iridocorneal angle is closed in gonioscopy "},{"correct":true,"justification":"True","idx":2,"proposition":"Myopia is a risk factor"},{"correct":false,"justification":"It is often present in Europe, but not always. In Asia, the majority of patients have normal intraocular pressure (IOP)","idx":3,"proposition":"There is always ocular hypertonia"},{"correct":true,"justification":"True","idx":4,"proposition":"The decrease in visual acuity is late and irreversible"}],"type":"custom"}
{"_id":"pancreatiteaigue-HGE-e4607f","context":null,"enonce":"Which of the following are among the exceptional causes of acute pancreatitis?","item":"pancreatiteaigue","matiere":"HGE","propositions":[{"correct":false,"justification":"Common cause (about 40% of HP) with chronic OH use","idx":0,"proposition":"Migration of a gallstone into the main bile duct "},{"correct":true,"justification":"","idx":1,"proposition":"Hypertriglyceridemia"},{"correct":true,"justification":"","idx":2,"proposition":"Hypercalcemia"},{"correct":false,"justification":"","idx":3,"proposition":"Hypocalcemia"},{"correct":true,"justification":"","idx":4,"proposition":"Medicinal"}],"type":"custom"}
{"_id":"suivinourisson-ophtalmo-fbbb18","context":null,"enonce":"From what age do we find a blink in bright light?","item":"suivinourisson","matiere":"ophtalmo","propositions":[{"correct":true,"justification":"True, according to the new college of pedatria (2021)","idx":0,"proposition":"From birth"},{"correct":false,"justification":"False","idx":1,"proposition":"At 2 weeks"},{"correct":false,"justification":"False","idx":2,"proposition":"between the ages of 2 and 4 months"},{"correct":false,"justification":"False","idx":3,"proposition":"between the ages of 6 and 12 months"},{"correct":false,"justification":"False","idx":4,"proposition":"between the ages of 12 and 24 months"}],"type":"custom"}
{"_id":"KcUt-onco-609618","context":null,"enonce":"Which of the following are true about HPV vaccination?","item":"KcUt","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"It is part of a primary prevention strategy"},{"correct":false,"justification":"Between 11 and 14 years old (before the first theoretical sexual intercourse, but the recall can be done after the latter)","idx":1,"proposition":"It is offered to all girls between 18 and 25 years old"},{"correct":false,"justification":"False","idx":2,"proposition":"It dispenses with screening"},{"correct":true,"justification":"True","idx":3,"proposition":"HPV infection is the leading cause of cervical tumor"},{"correct":false,"justification":"15 on average","idx":4,"proposition":"The latency between HPV infection and tumor development is 60 to 70 years"}],"type":"custom"}
{"_id":"KcUt-onco-c54f2e","context":null,"enonce":"Which of the following are true about the prognosis of endometrial cancer?","item":"KcUt","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Endometrioid adenocarcinoma has a better prognosis than clear cell carcinoma"},{"correct":true,"justification":"True","idx":1,"proposition":"Endometrioid adenocarcinoma accounts for 80% of endometrial cancers"},{"correct":true,"justification":"True","idx":2,"proposition":"FIGO classification is a prognostic factor"},{"correct":true,"justification":"True","idx":3,"proposition":"Clear cell carcinoma is histological type 2"},{"correct":true,"justification":"True","idx":4,"proposition":"All propositions are true"}],"type":"custom"}
{"_id":"330-urg-4d7614","context":null,"enonce":"Which of the following propositions are true about Lefort's classification?","item":"traumacrane","matiere":"urg","propositions":[{"correct":false,"justification":"This is the fracture of Lefort III","idx":0,"proposition":"Lefort I fracture is the only true craniofacial disjunction"},{"correct":true,"justification":"True","idx":1,"proposition":"An epistaxis can sign a Lefort I"},{"correct":false,"justification":"Lefort I. In the Lefort III, the fracture line crosses both orbits, \r\nthe root of the nose, the zygomatic arch and the orbital process of the zygomatic bones (formerly called \r\nmalar) and the upper part of the pterygoid process","idx":2,"proposition":"The fracture of Lefort III is due to subnasal shock"},{"correct":true,"justification":"True","idx":3,"proposition":"In Lefort I, the dental arch is clinically very mobile and there may be vestibular hematomas greater than \r\nendooral examination"},{"correct":false,"justification":"Systematic antibiotic therapy in Lefort fractures: these are all open fractures","idx":4,"proposition":"Lefort I does not require antibiotic therapy"}],"type":"custom"}
{"_id":"330-urg-dbd359","context":null,"enonce":"Which of the following are etiologies of traumatic otorrhagia?","item":"traumacrane","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Tympanal bone fracture "},{"correct":true,"justification":"True","idx":1,"proposition":"Eardrum wound "},{"correct":false,"justification":"No otorragia","idx":2,"proposition":"Zygomatic arch fracture"},{"correct":false,"justification":"Not traumatic","idx":3,"proposition":"Otitis externa"},{"correct":true,"justification":"True","idx":4,"proposition":"Wound of the external auditory canal"}],"type":"custom"}
{"_id":"359-urg-1a3421","context":null,"enonce":"Which of the following corresponds to the normal inclination of the bistyloid line (relative to the horizontal)?","item":"Fr","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"15°"},{"correct":false,"justification":"","idx":1,"proposition":"5°"},{"correct":false,"justification":"","idx":2,"proposition":"0°"},{"correct":false,"justification":"","idx":3,"proposition":"-5°"},{"correct":false,"justification":"","idx":4,"proposition":"-15°"}],"type":"custom"}
{"_id":"359-urg-a70622","context":null,"enonce":"In general, the diagnosis of compartment syndrome:","item":"Fr","matiere":"urg","propositions":[{"correct":true,"justification":"True, no need for additional examination most often","idx":0,"proposition":"Is purely clinical"},{"correct":true,"justification":"True, emergency surgical management for aponeurotomy of the compartments","idx":1,"proposition":"Is a surgical emergency"},{"correct":false,"justification":"Only in doubtful and complex cases","idx":2,"proposition":"By measuring pressure in the muscle compartments"},{"correct":false,"justification":"Clinical diagnosis","idx":3,"proposition":"On a scanner"},{"correct":false,"justification":"Clinical diagnosis","idx":4,"proposition":"On an X-ray"}],"type":"custom"}
{"_id":"287-onco-478dc0","context":null,"enonce":"Which of the following proposals are tumors subject to screening organized on the national territory?","item":"epidemioKc","matiere":"onco","propositions":[{"correct":true,"justification":"True, the only cancers subject to national organized screening are breast, colorectal and cervix.","idx":0,"proposition":"None of these proposals"},{"correct":false,"justification":"cf. Has","idx":1,"proposition":"Lung"},{"correct":false,"justification":"cf. Has","idx":2,"proposition":"Kidney"},{"correct":false,"justification":"cf. Has","idx":3,"proposition":"Prostate"},{"correct":false,"justification":"cf. Has","idx":4,"proposition":"Glioblastoma"}],"type":"custom"}
{"_id":"74-gastro-7729cf","context":null,"enonce":"Which of the following are true?","item":"OH","matiere":"HGE","propositions":[{"correct":false,"justification":"False. It's the other way around. Korsakoff syndrome is often secondary to poorly or untreated Gayet-Wernicke encephalopathy","idx":0,"proposition":"Gayet-Wernicke encephalopathy is often the consequence of poorly or untreated Korsakoff syndrome"},{"correct":false,"justification":"False. This is the triad of pellagreal encephalopathy. ","idx":1,"proposition":"Gayet-Wernicke encephalopathy combines a triad of clinical signs: diarrhea, dementia and dermatitis"},{"correct":true,"justification":"True. This is the other name for vitamin B1","idx":2,"proposition":"Gayet-Wernicke encephalopathy is secondary to thiamine deficiency"},{"correct":true,"justification":"True. There is a risk of withdrawal syndrome that can cause delirium tremens or seizure. ","idx":3,"proposition":"Vitamins B1, B6 and PP should be routinely prescribed to all hospitalized alcoholic patients, regardless of the reason for hospitalization."},{"correct":false,"justification":"False. Diagnosis is based on FLAIR MRI and vitamin B1 assay","idx":4,"proposition":"Diagnosis of Gayet-Wernicke encephalopathy is clinical"}],"type":"custom"}
{"_id":"343-urg-8b76abd5-5f78-49ce-985a-31b549bf012a","context":null,"enonce":"Which of the following are true about emergency dialysis?","item":"IRenA","matiere":"urg","propositions":[{"correct":false,"justification":"Requires several days\/weeks of preparation 😊","idx":0,"proposition":"Peritoneal dialysis is regularly used as an emergency dialysis technique"},{"correct":true,"justification":"True","idx":1,"proposition":"Emergency dialysis is primarily based on hemodialysis"},{"correct":false,"justification":"An AVF requires several weeks to be usable","idx":2,"proposition":"Emergency hemodialysis can be done on an arteriovenous fistula (AVF) placed in emergency"},{"correct":true,"justification":"True","idx":3,"proposition":"Using a hemodialysis catheter puts you at increased risk of infections"},{"correct":true,"justification":"True","idx":4,"proposition":"Hemodialysis catheters are usually placed transcutaneously into the femoral vein or the internal jugular vein."}],"type":"custom"}
{"_id":"autonomiegeria-mpr-b9cc2a","context":null,"enonce":"Fight low! You ask your external team, as part of Mr Blofeld's autonomy assessment, Ernst, 89 years old, to make the ADL and IADL score. It tells you that it can't remember ADL score items. Can you tell him?","item":"autonomiegeria","matiere":"mpr","propositions":[{"correct":true,"justification":"True, ADL corresponds to activities that are not \"instrumental\" and that are often directly related to the human body (eating, moving, washing, going to the toilet and continence, dressing)","idx":0,"proposition":"Ability to move"},{"correct":true,"justification":"True, see above","idx":1,"proposition":"Ability to wash"},{"correct":true,"justification":"True, see above","idx":2,"proposition":"Ability to go and do your business and continence"},{"correct":false,"justification":"False, part of the IADL","idx":3,"proposition":"Ability to shop"},{"correct":false,"justification":"False, part of the IADL","idx":4,"proposition":"Cleaning skills"}],"type":"custom"}
{"_id":"reeducation-mpr-894d06","context":null,"enonce":"Panic on board! You need to make a physiotherapy prescription for Mr Wayne, Bruce, 45, who suffers from sciatica that is struggling to heal. What should be on the prescription you are going to write?","item":"reeducation","matiere":"mpr","propositions":[{"correct":false,"justification":"False, The diagnosis must be written elsewhere, on a separate letter, given to the masseur-physiotherapist","idx":0,"proposition":"Diagnosis of acute lumbosciatica"},{"correct":true,"justification":"True, we will talk more about the region to be treated, here the lumbosacral spine, more than the diagnosis.","idx":1,"proposition":"The area to be treated"},{"correct":false,"justification":"False, it is at the discretion of the masseur-physiotherapist","idx":2,"proposition":"The recommended exercises to perform"},{"correct":false,"justification":"False, it is at the discretion of the masseur-physiotherapist","idx":3,"proposition":"The duration of care and the number of sessions"},{"correct":true,"justification":"True, there are also the mentions \"At home\", \"Accident at work\", \"Balneotherapy\"...","idx":4,"proposition":"If necessary the mention every day, including weekends and public holidays"}],"type":"custom"}
{"_id":"151-pneumo-7729d1c5-a724-435e-86e7-1f8a04511a5e","context":null,"enonce":"You are an intern in the emergency room in your area, and your department is literally overflowing with patients, especially since hospital places are expensive... you have just examined Mr Graves, Gustav, 72, who presents for a productive febrile cough with dyspnea. You then hesitate to hospitalize him but fortunately you remember the CRB65, score where each item of the latter is an indication of hospitalization. What elements here would indicate hospitalization?","item":"IBP","matiere":"pneumo","propositions":[{"correct":true,"justification":"True, the C of the CRB65 is for confusion, so a Glasgow <15","idx":0,"proposition":"Glasgow score at 14"},{"correct":false,"justification":"False, tachycardia (>90bpm) is part of SRIS but not CRB65","idx":1,"proposition":"A pulse at 100bpm"},{"correct":false,"justification":"False, the CRB65 is based only on the anamnesis and clinical examination","idx":2,"proposition":"A chest x-ray showing acute lobar frank pneumonitis"},{"correct":true,"justification":"True, the R for breathing and the B for Blood!","idx":3,"proposition":"A polypnea with more than 30 cycles per minute and\/or low blood pressure (BPs <90mmHG, TAd <60mmHg)"},{"correct":true,"justification":"True, the 65 is for >65 years","idx":4,"proposition":"At the anamnesis, you already have a criterion of hospitalization"}],"type":"custom"}
{"_id":"somatopsy-psy-15bcb3","context":null,"enonce":"Regarding somatoform disorders, which of the following propositions, which one or which are true?","item":"somatopsy","matiere":"psy","propositions":[{"correct":false,"justification":"False, it is a huge trap, but a somatoform disorder is a psychiatric disorder, while a psychosomatic disorder is a medical condition where stress is a risk factor (e.g. eczema)","idx":0,"proposition":"Somatoform disorder and psychosomatic disorder are synonymous"},{"correct":false,"justification":"False, these two pathologies have very little in common. Once again somatoform pain syndrome is a psychiatric disease that will lead to a perpetuation of pain, while in algoneurodystrophy we have a dysregulation of the pain system and inflammation","idx":1,"proposition":"Somatoform pain syndromes include algoneurodystrophy or complex regional pain syndrome"},{"correct":true,"justification":"True, and beware of the 30-year-old level, diagnostic subtlety, rarely retained","idx":2,"proposition":"To make the diagnosis of a somatization disorder, it is necessary that the pathology began before the age of 30, that it has functional repercussions and that the complementary examinations are normal"},{"correct":true,"justification":"True, MCQ that calls on semiological knowledge of psychiatry. Judgment is the patient's perception of their disorder. In the somatoform disorder the patient is anosognosic most often, he is convinced that he has no psychiatric disorder and that he has a real somatic disease. While in factitious disorder the patient mimics symptoms in order to obtain care and benefits","idx":3,"proposition":"A somatoform disorder and a factitious disorder are different, with respect to the patient's judgment of his disorder."},{"correct":true,"justification":"True, it is simply the treatment of these disorders","idx":4,"proposition":"Therapeutic management includes therapeutic education, psychotherapy and sometimes an antidepressant"}],"type":"custom"}
{"_id":"TED-psy-c25f45","context":null,"enonce":"Children with autism spectrum disorder (ASD) have deficits in which 2 clinical areas?","item":"TED","matiere":"psy","propositions":[{"correct":true,"justification":"","idx":0,"proposition":"Anomalies in communication and social interactions"},{"correct":false,"justification":"","idx":1,"proposition":"Motor abnormalities"},{"correct":true,"justification":"","idx":2,"proposition":"Restricted and repetitive nature of behaviour, interests of activities"},{"correct":false,"justification":"It is a common comorbidity (30%), but does not fall within the definition of ASD.","idx":3,"proposition":"Attention deficit hyperactivity disorder"},{"correct":false,"justification":"It is a common comorbidity (40%). Moreover, there are forms of autism spectrum disorders without intellectual disability with an IQ > 70: it is Asperger's syndrome","idx":4,"proposition":"Intellectual disability"}],"type":"custom"}
{"_id":"52-ortho-1b1e8c8b-f948-46ea-a3dd-15afaed260d5","context":null,"enonce":"Regarding Congenital Hip Dysplasia, which of the following are true?","item":"boiterieped","matiere":"ortho","propositions":[{"correct":false,"justification":"3-20\/1000","idx":0,"proposition":"It concerns 3-20\/100,000 children in France."},{"correct":true,"justification":"True","idx":1,"proposition":"Congenital torticollis is a risk factor."},{"correct":true,"justification":"True","idx":2,"proposition":"Breech birth is a risk factor."},{"correct":false,"justification":"False: This is a common field but does not count in the list of risk factors.","idx":3,"proposition":"European origin is a risk factor."},{"correct":false,"justification":"Abduction Nle > 60° Imaging, but > 4 months: Basin Radio","idx":4,"proposition":"A hip ultrasound should be performed on a 5-month-old child if an Abduction is measured at 50°"}],"type":"custom"}
{"_id":"radiculalgie-ortho-c28f18","context":null,"enonce":"Which of the following refer to muscles innervated by the ulnar nerve?","item":"radiculalgie","matiere":"ortho","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Opponent of the 5th ray"},{"correct":true,"justification":"True","idx":1,"proposition":"Deep leader of the short flexor of the thumb"},{"correct":true,"justification":"True","idx":2,"proposition":"Adductor of the thumb"},{"correct":false,"justification":"Medial nerve","idx":3,"proposition":"Abductor of the thumb"},{"correct":false,"justification":"Radial nerve","idx":4,"proposition":"5th ray extender"}],"type":"custom"}
{"_id":"hemorroides-HGE-df9fb1","context":null,"enonce":"What is the name of the classification of hemorrhoidal prolapse?","item":"hemorroides","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Goligher "},{"correct":false,"justification":"Diverticulitis","idx":1,"proposition":"Hinchey"},{"correct":false,"justification":"Lymphoma","idx":2,"proposition":"Ann Arbor"},{"correct":false,"justification":"Staining of stool","idx":3,"proposition":"Bristol"},{"correct":false,"justification":"Bedsore","idx":4,"proposition":"Norton"}],"type":"custom"}
{"_id":"RGO-HGE-015a7d","context":null,"enonce":"What is the type of endobrachyoesophageal epithelium?","item":"RGO","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"It is an intestinal type epithelium"},{"correct":true,"justification":"True","idx":1,"proposition":"Columnar epithelium"},{"correct":false,"justification":"","idx":2,"proposition":"Simple squamous epithelium"},{"correct":false,"justification":"Normal epithelium of the esophagus (the same as the vagina)","idx":3,"proposition":"Non-keratinized stratified squamous epithelium"},{"correct":false,"justification":"Skin","idx":4,"proposition":"Keratinized stratified squamous epithelium "}],"type":"custom"}
{"_id":"cirrhose-HGE-e5e596","context":null,"enonce":"Cytolysis in favor of acute alcoholic hepatitis predominates on:","item":"cirrhose","matiere":"HGE","propositions":[{"correct":true,"justification":"True, = TGO","idx":0,"proposition":"ASAT"},{"correct":true,"justification":"True, = ASAT","idx":1,"proposition":"TGO"},{"correct":false,"justification":"","idx":2,"proposition":"ALAT"},{"correct":false,"justification":"Cholestasis marker","idx":3,"proposition":"STAKE"},{"correct":false,"justification":"Cholestasis marker","idx":4,"proposition":"GGT"}],"type":"custom"}
{"_id":"hernie-HGE-70802c","context":null,"enonce":"Which of the following are signs of a strangulated hernia?","item":"hernie","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Pain"},{"correct":true,"justification":"True","idx":1,"proposition":"Non-impulsive to cough"},{"correct":true,"justification":"True","idx":2,"proposition":"Irreducible"},{"correct":true,"justification":"True","idx":3,"proposition":"All propositions are true"},{"correct":true,"justification":"True, nausea, vomiting, stopping materials and gases, bloating","idx":4,"proposition":"Occlusive signs"}],"type":"custom"}
{"_id":"UGD-HGE-2be236","context":null,"enonce":"Regarding the typical pain of uclera:","item":"UGD","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"It is calmed by food"},{"correct":false,"justification":"","idx":1,"proposition":"It is aggravated by meals"},{"correct":false,"justification":"This is the case of pancreatitis","idx":2,"proposition":"It radiates into the back"},{"correct":true,"justification":"True","idx":3,"proposition":"It can be accompanied by a localized defense"},{"correct":false,"justification":"Atypical symptomatology is common","idx":4,"proposition":"It is always typical"}],"type":"custom"}
{"_id":"RGO-HGE-848ba0","context":null,"enonce":"What proportion of adults are affected by pyrosis?","item":"RGO","matiere":"HGE","propositions":[{"correct":false,"justification":"","idx":0,"proposition":"5 %"},{"correct":false,"justification":"","idx":1,"proposition":"10 %"},{"correct":false,"justification":"","idx":2,"proposition":"20 %"},{"correct":false,"justification":"","idx":3,"proposition":"30 %"},{"correct":true,"justification":"True","idx":4,"proposition":"40 %"}],"type":"custom"}
{"_id":"pathosalivaire-ORL-caea8c","context":null,"enonce":"Which of the following are non-epithelial tumors of the salivary glands?","item":"pathosalivaire","matiere":"ORL","propositions":[{"correct":true,"justification":"True, benign tumor","idx":0,"proposition":"Hemangioma"},{"correct":false,"justification":"Simple epithelial adenoma","idx":1,"proposition":"Cystadenolymphome"},{"correct":true,"justification":"True, benign nerve tumor (at the expense of Schwann cells)","idx":2,"proposition":"Schwannoma"},{"correct":false,"justification":"Epithelial carcinoma (cylindroma)","idx":3,"proposition":"Adenoid cystic carcinoma"},{"correct":false,"justification":"Most common, epithelial tumor","idx":4,"proposition":"Pleomorphic adenoma"}],"type":"custom"}
{"_id":"tbauditif-ORL-e7fe5c","context":null,"enonce":"Which of the following propositions are true about otosclerosis?","item":"tbauditif","matiere":"ORL","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Otosclerosis causes conductive hearing loss with normal eardrums"},{"correct":true,"justification":"True","idx":1,"proposition":"There is no tympanic retraction"},{"correct":false,"justification":"Female 👩 predominance","idx":2,"proposition":"The sex ratio is 2:1 with male predominance 👨"},{"correct":false,"justification":"CT of rocks","idx":3,"proposition":"Diagnosis requires MRI"},{"correct":true,"justification":"True","idx":4,"proposition":"There is about 15% familial form 👨 👩 👧 👦"}],"type":"custom"}
{"_id":"IBP-infectio-ef3511","context":null,"enonce":"Which of the following are true about pneumocystosis?","item":"IBP","matiere":"infectio","propositions":[{"correct":false,"justification":"Frosted glass opacities, lung nodules, cystic images, pneumothorax. Radio sometimes misleading","idx":0,"proposition":"Chest X-ray highlights systematized alveolar condensation"},{"correct":false,"justification":"Opportunistic infection of patients with cellular immunosuppression (HIV, hematology, immunosuppressants...)","idx":1,"proposition":"It is favored by prolonged neutropenia"},{"correct":true,"justification":"True, with the patient's consent","idx":2,"proposition":"HIV serology should be performed"},{"correct":false,"justification":"False, Pneumocystis is a fungus","idx":3,"proposition":"It is due to a parasite"},{"correct":false,"justification":"False, diagnosis mainly provided by PCR on sputum or LBA fluid","idx":4,"proposition":"Diagnosis of pneumocystis based on serology"}],"type":"custom"}
{"_id":"deuil-psy-37e195","context":null,"enonce":"Regarding pathological bereavement, what are the exact proposal(s)?","item":"deuil","matiere":"psy","propositions":[{"correct":true,"justification":"True, these three steps are essential to identify during successive interviews in patients","idx":0,"proposition":"Classic grief is characterized by 3 phases: stupefaction, painful emotional phase, reorganization phase"},{"correct":true,"justification":"True, this is a suicidal risk situation ","idx":1,"proposition":"Grief can lead to reactive suicide"},{"correct":false,"justification":"False, we talk about pathological grief from 12 months of symptomatology, 6 months is for children","idx":2,"proposition":"We talk about pathological bereavement from 6 months of symptomatology"},{"correct":false,"justification":"False, crude trap.","idx":3,"proposition":"We do not talk about pathological grief in the child, because he does not understand the notion of death"},{"correct":false,"justification":"False. If supportive therapy and empathetic listening are the very basis of care, antidepressants are not prescribed and anxiolytics are abhorred","idx":4,"proposition":"A pathological bereavement benefits from a management by supportive psychotherapy, empathic listening, antidepressant and \/ or anxiolytics"}],"type":"custom"}
{"_id":"deuil-psy-490162","context":null,"enonce":"You receive Mr. Bond, James, 45 years old in your general practice, he lost his wife Teresa 9 months ago and he talks very often about her and the circumstances of her disappearance. Rightly you suspect pathological bereavement, which of the following elements would direct you towards this pathology?","item":"deuil","matiere":"psy","propositions":[{"correct":false,"justification":"False, this is normal grief. Pathological grief would be characterized by persistent depressed mood.","idx":0,"proposition":"A feeling of emptiness and loss related to the state of lack of the deceased"},{"correct":true,"justification":"True","idx":1,"proposition":"Self-critical, fatalistic, guilt-inducing or pessimistic ruminations"},{"correct":true,"justification":"True","idx":2,"proposition":"Collapsed self-esteem"},{"correct":false,"justification":"False, this is normal grief. Pathological grief is characterized by a real depressive episode characterized with an intense and major suicidal crisis.","idx":3,"proposition":"Thoughts of suicide centered on \"joining the deceased\""},{"correct":false,"justification":"False, this is normal grief. Pathological bereavement will be characterized by ruminations cf. B","idx":4,"proposition":"Concerns and remembrance about the deceased"}],"type":"custom"}
{"_id":"EI-infectio-27812f","context":null,"enonce":"Regarding infectious endocarditis, what are the exact proposal(s)?","item":"EI","matiere":"infectio","propositions":[{"correct":false,"justification":"False, it is the cocci gram + that are more than predominant in endocarditis since they cover more than 85% of endocarditis germs (staph, CGP in clusters + strepto, diplococcus)","idx":0,"proposition":"The germs that will be predominant in infectious endocarditis are gram-positive cocci and gram-negative bacilli."},{"correct":true,"justification":"True, these are the two main causes that will involve prevention by antibiotic therapy during dental care for example 🦷 (+ history of IE)","idx":1,"proposition":"High-risk heart disease in infective endocarditis is prosthetic heart valves and congenital heart disease"},{"correct":false,"justification":"False, for two reasons: An ETT sees vegetation very badly, that's why we will prefer an ETO and to explore finely the mitral valve which is quite small, the ETT is not effective enough","idx":2,"proposition":"In case of endocarditis with suspicion of mitral vegetation, ETT alone will often be used"},{"correct":true,"justification":"True, it's all said 😌","idx":3,"proposition":"The choice of antibiotic therapy depends on the germ in question, the nosocomial or community character and the notion of valve prosthesis or not"},{"correct":true,"justification":"True, this is one of the few causes where we will carry out this daily monitoring.","idx":4,"proposition":"Monitoring for infective endocarditis requires daily blood cultures until negativation"}],"type":"custom"}
{"_id":"153-infectio-79ac28ae-e2ff-4e9a-85bc-3e87fa4fcba3","context":null,"enonce":"Intern in the emergency room, you receive Mr. Beam, Gregory, 67 years old for a febrile joint effusion. Instinctively you turn to septic arthritis and you decide to perform a joint puncture. Which of the following are true?","item":"IOA","matiere":"infectio","propositions":[{"correct":true,"justification":"True, this is the semiology of a joint effusion of the knee.","idx":0,"proposition":"You affirmed the effusion by highlighting a sign of the flow and a patellar shock"},{"correct":false,"justification":"False, we bite in the external upper quadrant between the patella and the femur, in the subquadricipital bursa.","idx":1,"proposition":"You place your needle for puncture at the level of the lower outer quadrant of the knee"},{"correct":false,"justification":"False, it may be a traumatic fluid","idx":2,"proposition":"If your sample contains blood, it will necessarily be hemarthrosis"},{"correct":true,"justification":"True, very important","idx":3,"proposition":"Purulent fluid is an indication for probabilistic antibiotic therapy"},{"correct":true,"justification":"True, logically","idx":4,"proposition":"A neutrophil polynucleosis (>2000\/mm3) in the joint fluid will support your diagnosis "}],"type":"custom"}
{"_id":"156-infectio-a3dfd1f2-b108-4089-b40e-15b12f38e98d","context":null,"enonce":"You receive Mr Silva, Raoul, 55 years old, farmer, who injured his leg while installing the barbed wire of his cow field. The wound may be superficial, but there is debris of earth and the patient tells you that the fence was a little rusty. When you ask him if he is up to date in his tetanus vaccination he looks at you with big round eyes and answers with a dazed look that he has no idea... What do you do after wound treatment?","item":"tetanos","matiere":"infectio","propositions":[{"correct":false,"justification":"False, cf. C","idx":0,"proposition":"Tetanus vaccination booster only"},{"correct":false,"justification":"False, serotherapy is never done alone","idx":1,"proposition":"Anti-tetanus serotherapy alone"},{"correct":true,"justification":"True, tetanus is a more than minor item of the Pilly, but this situation is the only one that is really required of the item. The fact that it is not up to date (or at least we have a doubt), requires vaccination or serovaccination. Here, the wound is dirty (earth) so we do a serovaccination rather than a vaccination alone.","idx":2,"proposition":"Tetanus serovaccination"},{"correct":false,"justification":"False, it's an emergency","idx":3,"proposition":"Determination of tetanus antibodies before any serovaccination"},{"correct":false,"justification":"False, cf. C.","idx":4,"proposition":"Nothing at all"}],"type":"custom"}
{"_id":"IST-infectio-d8c151","context":null,"enonce":"What is the first-line treatment for Neisseria gonorrhoeae?","item":"IST","matiere":"infectio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Ceftriaxone "},{"correct":false,"justification":"Treponema pallidum","idx":1,"proposition":"Penicillin G"},{"correct":false,"justification":"Chlamydia trachomatis","idx":2,"proposition":"Doxycycline"},{"correct":false,"justification":"HSV","idx":3,"proposition":"Valaciclovir"},{"correct":false,"justification":"Trichomonas vaginalis","idx":4,"proposition":"Metronidazole "}],"type":"custom"}
{"_id":"175-gastro-b3b63161-4174-4502-a8bf-063e4ae81aba","context":null,"enonce":"You receive in consultation Mr Sansei, Rupan, 35 years old, who comes to see you because he and his family present since this afternoon an intense digestive symptomatology (diarrhea, nausea, vomiting, abdominal pain) without fever. During your interrogation, he told you that he was at a wedding meal that very noon and that he gorged himself on petit fours, and pastries... With this, what germ do you suspect in front of this table of Collective Food Infection Toxi (TIAC)?","item":"risquesenvironnemt","matiere":"HGE","propositions":[{"correct":false,"justification":"False, it takes at least 12 hours of incubation and it gives acute febrile diarrhea","idx":0,"proposition":"Salmonella enterica"},{"correct":true,"justification":"True, very short period of action and S. aureus is often implicated in front of milk derivatives, catering dishes etc ...","idx":1,"proposition":"Staphylococcus aureus"},{"correct":false,"justification":"False, the picture is often that of isolated diarrhea.","idx":2,"proposition":"Clostridium Perfringens"},{"correct":false,"justification":"False, the time of action is 24 to 48 hours","idx":3,"proposition":"Norovirus"},{"correct":false,"justification":"False, E. coli does not give TIAC","idx":4,"proposition":"E. Coli"}],"type":"custom"}
{"_id":"189-immuno-4882b5bf-54f6-488a-943f-1322acb06203","context":null,"enonce":"Which of the following are signs or symptoms of giant cell arteritis (Horton's disease)?","item":"vascularite","matiere":"immuno","propositions":[{"correct":true,"justification":"","idx":0,"proposition":"Headache"},{"correct":true,"justification":"\"Sign of the comb\" characterized by pain during hairdressing in particular","idx":1,"proposition":"Hyperesthesia of the scalp"},{"correct":true,"justification":"","idx":2,"proposition":"Claudication of the jaw"},{"correct":true,"justification":"","idx":3,"proposition":"Decreased or absent temporal pulse"},{"correct":true,"justification":"Ophthalmological signs are important because they involve the functional prognosis: transient amaurosis, diplopia or even irreversible blindness by NOIAA","idx":4,"proposition":"NOIAA"}],"type":"custom"}
{"_id":"Kcsein-onco-7d971e","context":null,"enonce":"Regarding the assessment of the extension of breast cancer. Which of the following are true?","item":"Kcsein","matiere":"onco","propositions":[{"correct":false,"justification":"False. Only if the cancer is classified as T3, T4 or N1. An extension assessment is not done if the cancer is classified as T1 or T2. ","idx":0,"proposition":"The extension assessment is systematic for all breast cancers. "},{"correct":true,"justification":"True. According to the recommendations, there are 3 ways to make the extension assessment: 1. Chest X-ray + abdominal ultrasound + bone scintigraphy (no longer done in real life, it's a little archaic); 2. Injected CT-TAP + bone scan; 3. FDG CT-PET. The goal is to look for the most common metastases in breast cancer: liver, lung and bone. ","idx":1,"proposition":"Chest X-ray, abdominal ultrasound and bone scintigraphy"},{"correct":false,"justification":"False. Brain MRI is not part of the extension workup unless there is a clinical call point. The only tumor where brain MRI is systematic is lung cancer","idx":2,"proposition":"CT-TAP, bone scintigraphy and brain MRI"},{"correct":false,"justification":"False. If you do the CT-PET scan, you will not do the bone scan because it is useless. ","idx":3,"proposition":"FDG CT-PET with bone scintigraphy"},{"correct":false,"justification":"False. CT-TAP + bone scan. ","idx":4,"proposition":"AP-CT, chest X-ray and bone scintigraphy"}],"type":"custom"}
{"_id":"189-immuno-622ce9e9-338a-4aa6-88ec-2234dbe53598","context":null,"enonce":"Which of the following propositions are true regarding pulmonary vasculitis involvement?","item":"vascularite","matiere":"immuno","propositions":[{"correct":true,"justification":"True, it's text in college 😏","idx":0,"proposition":"It is only seen during small-caliber vasculitis"},{"correct":false,"justification":"This is the case in granulomatosis with polyangiitis (Wegener)","idx":1,"proposition":"Eosinophilic granulomatosis with polyangiitis (Churg-Strauss) is accompanied by pulmonary nodules sometimes excavated"},{"correct":false,"justification":"Pulmonary infiltrates can be found in all ANCA vasculitis","idx":2,"proposition":"Pulmonary infiltrates can be found in IgA vasculitis"},{"correct":true,"justification":"True","idx":3,"proposition":"Vasculitis with anti-MBG antibodies may be accompanied by pneumorenal syndrome"},{"correct":false,"justification":"ENT involvement = granulomatous ANCA vasculitis. HIA involvement (intraalveolar hemorrhage) = microscopic polyangiitis +++","idx":4,"proposition":"Microscopic polyangiitis may be accompanied by sinusitis"}],"type":"custom"}
{"_id":"UGD-HGE-119db1","context":null,"enonce":"What is the sex ratio of duodenal ulcer?","item":"UGD","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"👩 1 - 2 👨"},{"correct":false,"justification":"This is the case of gastric ulcer","idx":1,"proposition":"👩 1 - 1 👨"},{"correct":false,"justification":"","idx":2,"proposition":"👩 3 - 1 👨"},{"correct":false,"justification":"","idx":3,"proposition":"👩 1 - 3 👨"},{"correct":false,"justification":"","idx":4,"proposition":"👩 2 - 1 👨"}],"type":"custom"}
{"_id":"UGD-HGE-085620","context":null,"enonce":"Which of the following are differential ulcer diagnoses?","item":"UGD","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Pancreatitis"},{"correct":true,"justification":"True","idx":1,"proposition":"Hepatic colic"},{"correct":false,"justification":"Hypogastric pain","idx":2,"proposition":"Bladder globe"},{"correct":false,"justification":"Well it's not too much the same place what 🤷 ♂️","idx":3,"proposition":"Fracture of the upper end of the femur"},{"correct":true,"justification":"True","idx":4,"proposition":"Lower acute coronary syndrome"}],"type":"custom"}
{"_id":"tbneuroSegeria-geria-9a4328","context":null,"enonce":"You see in your Geriatric SSR department, Mr. Gérard Bouchard, 99 years old, who shouts to anyone who will listen \"THAT HE IS NOT DEAF\", despite the fact that he repeats everything. What signs and symptoms make you suspect classic presbycusis?","item":"tbneuroSegeria","matiere":"geria","propositions":[{"correct":true,"justification":"True, typically presbycusis is bilateral","idx":0,"proposition":"Bilateral involvement"},{"correct":true,"justification":"True, sign name that could fall in DP at the ECN, the cocktail party sign is a deafness that is aggravated by noisy situations. Presbycusis being a sensorineural hearing loss, the large number of extraneous noises will worsen the understanding","idx":1,"proposition":"A sign of \"Cocktail Party\""},{"correct":true,"justification":"True, very classic","idx":2,"proposition":"A very noisy sound environment (TV, radio\/music) "},{"correct":false,"justification":"False, patients have a feeling of blocked ear. Semiological subtlety, the sensation of ears full of water are rather found in seromucosal otitis (or tympanic ventilation defect)","idx":3,"proposition":"An ear feeling full of water"},{"correct":true,"justification":"True, the caricature example of the statement is true! 😅","idx":4,"proposition":"Anosognosia"}],"type":"custom"}
{"_id":"Kcpancreas-onco-fcf292","context":null,"enonce":"Which of the following are true?","item":"Kcpancreas","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Adenocarcinoma is the most common pancreatic tumour"},{"correct":false,"justification":"This is tobacco","idx":1,"proposition":"The most important risk factor is age"},{"correct":true,"justification":"True","idx":2,"proposition":"TIPMP can be treated to prevent degeneration "},{"correct":false,"justification":"CT \/ MRI \/ Endoscopic ultrasound","idx":3,"proposition":"Diagnosis of pancreatic tumors is based on ultrasound"},{"correct":false,"justification":"R0 (complete resection) than in 10% of cases","idx":4,"proposition":"Surgical resection is R0 only in 60% of cases"}],"type":"custom"}
{"_id":"vomisst-HGE-e7455b","context":null,"enonce":"Which of the following are emetogenic treatments?","item":"vomisst","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Colchicine"},{"correct":true,"justification":"True","idx":1,"proposition":"Levo-Dopa"},{"correct":true,"justification":"True","idx":2,"proposition":"Quinine"},{"correct":false,"justification":"","idx":3,"proposition":"Amniodarone"},{"correct":false,"justification":"","idx":4,"proposition":"Aminoglycoside"}],"type":"custom"}
{"_id":"violence-gyn-0fd938","context":null,"enonce":"Regarding sexual violence, which of the following proposition(s) is true?","item":"violence","matiere":"gyn","propositions":[{"correct":false,"justification":"False, The majority of rapes occur in minors","idx":0,"proposition":"More than half of rapes occur in adults"},{"correct":true,"justification":"True, sexual violence can cause traumatic shock, depression or suicide.","idx":1,"proposition":"It is essential to assess the initial psychological consequences for a victim of sexual violence"},{"correct":false,"justification":"False, The care of a victim of sexual violence is preferentially done by a requisition (especially for paramedical samples to genetically identify the aggressor) but this procedure is in no way mandatory","idx":2,"proposition":"The care of a victim of sexual violence is mandatory via a requisition"},{"correct":true,"justification":"True, for example, the assault may be old (several years), and in general, the victim's word is not initially questioned. ","idx":3,"proposition":"A normal clinical examination does not call into question sexual assault or violence"},{"correct":false,"justification":"False, these local samples look for the presence of Gonococcus and Chlamydia. HIV\/HBV\/HCV are tested by blood test. ","idx":4,"proposition":"Local samples (cervix, vagina, urethra, anus, throat) can detect via PCR the presence of DNA or viral RNA of HIV\/HBV\/HCV viruses"}],"type":"custom"}
{"_id":"Frped-urg-a41603","context":null,"enonce":"Which of the following are true?","item":"Frped","matiere":"urg","propositions":[{"correct":false,"justification":"Two boys for one girl","idx":0,"proposition":"The sex ratio of child fractures is ten boys to one girl"},{"correct":true,"justification":"","idx":1,"proposition":"A traumatic mechanism discordant with the observed fracture must in particular search for a tumor "},{"correct":true,"justification":"It depends only on the fracture line","idx":2,"proposition":"The classification of Salter and Harris is independent of the displacement of the fracture"},{"correct":false,"justification":"By orthopedic treatment","idx":3,"proposition":"A Salter 2 fracture will be managed by surgical treatment"},{"correct":false,"justification":"Epiphysiodesis is a complication of Salter 5 fractures. It can also be iatrogenic in case of inappropriate treatment.","idx":4,"proposition":"A Salter 5 fracture will be treated with epiphysiodesis "}],"type":"custom"}
{"_id":"PF-neuro-eff5a0","context":null,"enonce":"The facial nerve is a nerve:","item":"PF","matiere":"neuro","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Engine"},{"correct":true,"justification":"True","idx":1,"proposition":"Sensitive"},{"correct":true,"justification":"True","idx":2,"proposition":"Sensory"},{"correct":true,"justification":"True","idx":3,"proposition":"Vegetative"},{"correct":true,"justification":"True","idx":4,"proposition":"All propositions are true"}],"type":"custom"}
{"_id":"MICI-HGE-7a8e56","context":null,"enonce":"Which of the following are differential diagnoses of UC?","item":"MICI","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Rectosigmoiditis "},{"correct":true,"justification":"True","idx":1,"proposition":"syphilis"},{"correct":true,"justification":"True","idx":2,"proposition":"amybiasis"},{"correct":true,"justification":"True","idx":3,"proposition":"Gonorrhea"},{"correct":true,"justification":"True","idx":4,"proposition":"chlamydia"}],"type":"custom"}
{"_id":"353-HGE-e0454353-57fe-4221-a44d-ce89b439c085","context":null,"enonce":"43-year-old patient, with a history of chronic alcoholism, presents to the emergency room for sudden onset epigastric pain \r\n\r\nWhat will be the exams to be carried out in a first 1 time?   ","item":"pancreatiteaigue","matiere":"HGE","propositions":[{"correct":true,"justification":"True. Lower myocardial infarction is a differential diagnosis to evoke in this situation ","idx":0,"proposition":"ECG"},{"correct":false,"justification":"False. Not right away. It can be done in a 2nd time if we find a cardiac ischemic cause to evaluate hemodynamics","idx":1,"proposition":"ETT"},{"correct":true,"justification":"True. The positive diagnosis of acute pancreatitis is based on the combination of PAIN + LIPASE > 3N. In addition, an associated significant cytolysis is in favor of a biliary origin of this pancreatitis","idx":2,"proposition":"Determination of lipase"},{"correct":false,"justification":"False. It has not been recommended for more than 5 years","idx":3,"proposition":"Determination of amylase"},{"correct":false,"justification":"False. Not right away. In case of confirmed acute pancreatitis, the AP CT scan should be performed at 48h-72h. On the other hand, abdominal ultrasound will be done as soon as the diagnosis is confirmed in order to eliminate a lithiatic cause","idx":4,"proposition":"Abdominal-pelvic CT"}],"type":"custom"}
{"_id":"droits-sp-bf50ae","context":null,"enonce":"How many years should a medical record be kept after a consultation (with a living adult)?","item":"droits","matiere":"sp","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"20 years"},{"correct":false,"justification":"After the death of a patient","idx":1,"proposition":"10 years"},{"correct":false,"justification":"False","idx":2,"proposition":"5 years"},{"correct":false,"justification":"False","idx":3,"proposition":"28 years"},{"correct":false,"justification":"False","idx":4,"proposition":"3 years"}],"type":"custom"}
{"_id":"Kcprostate-onco-bf479f","context":null,"enonce":"Which of the following are true about enzalutamide?","item":"Kcprostate","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"It is an androgen receptor inhibitor that prevents their translocation into the nucleus and their attachment to DNA."},{"correct":false,"justification":"Per Os","idx":1,"proposition":"It is administered in IV"},{"correct":false,"justification":"It lowers it (thus increasing the risk of comitial crisis)","idx":2,"proposition":"Its main adverse effect is to increase the epileptogenic threshold"},{"correct":false,"justification":"Liver toxicity","idx":3,"proposition":"It has kidney toxicity"},{"correct":true,"justification":"True","idx":4,"proposition":"It improves overall survival and symptom-free survival"}],"type":"custom"}
{"_id":"HTA-cardio-d864f7","context":null,"enonce":"Which of the following propositions concerning essential hypertension are true?","item":"HTA","matiere":"cardio","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Cardiovascular risk doubles for SBP elevation of 20 mmHg"},{"correct":false,"justification":"It is more common in women and black subjects.","idx":1,"proposition":"Essential hypertension is more common in humans."},{"correct":false,"justification":"135\/85mmHg are the thresholds allowing the diagnosis of hypertension by blood pressure self-measurement.\r\nFor MAPA, the thresholds are: ≥ 130\/80 mmHg over 24 hours or ≥ 135\/85 when awake or ≥ 120\/70 at sleep.","idx":2,"proposition":"The MAPA (ambulatory measurement of BP) allows the diagnosis of hypertension if the average over 24 hours is ≥ 135\/85 mmHg."},{"correct":false,"justification":"130\/80 mmHg are the thresholds allowing the diagnosis of hypertension over 24 hours by MAPA. For blood pressure self-measurement, the diagnosis of hypertension is made for a BP ≥ 135\/85 on average.","idx":3,"proposition":"Blood pressure self-measurement allows the diagnosis of hypertension if the mean is ≥ 130\/80 mmHg."},{"correct":true,"justification":"True","idx":4,"proposition":"Essential hypertension multiplies the risk of stroke by a factor of 7."}],"type":"custom"}
{"_id":"lithiaseB-HGE-becad8","context":null,"enonce":"How common is cholelithiasis in Western countries?","item":"lithiaseB","matiere":"HGE","propositions":[{"correct":true,"justification":"True, it reaches 60% after 80 years","idx":0,"proposition":"20 %"},{"correct":false,"justification":"","idx":1,"proposition":"100 %"},{"correct":false,"justification":"","idx":2,"proposition":"80 %"},{"correct":false,"justification":"","idx":3,"proposition":"50 %"},{"correct":false,"justification":"","idx":4,"proposition":"2 %"}],"type":"custom"}
{"_id":"matraitanceped-sp-2bfaa2","context":null,"enonce":"Which of the following propositions are true regarding judicial reporting?","item":"matraitanceped","matiere":"sp","propositions":[{"correct":false,"justification":"To the public prosecutor","idx":0,"proposition":"It is intended for the Inspector of Child Welfare"},{"correct":true,"justification":"True","idx":1,"proposition":"It is purely descriptive"},{"correct":true,"justification":"True","idx":2,"proposition":"It is accompanied by a social report"},{"correct":false,"justification":"The latter is done in the absence of urgency and leads to an evaluation within three months","idx":3,"proposition":"It's the same as worrying information"},{"correct":true,"justification":"True","idx":4,"proposition":"The public prosecutor is seized"}],"type":"custom"}
{"_id":"pancreatitechr-HGE-2eaaae","context":null,"enonce":"What is the pace of monitoring for the occurrence of pancreatic adenocarcinoma in chronic pancreatitis?","item":"pancreatitechr","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Low risk, no specific monitoring"},{"correct":false,"justification":"","idx":1,"proposition":"Every 2 years "},{"correct":false,"justification":"","idx":2,"proposition":"Every 5 years "},{"correct":false,"justification":"","idx":3,"proposition":"Every 6 months"},{"correct":false,"justification":"","idx":4,"proposition":"Every 3 years "}],"type":"custom"}
{"_id":"splenomeg-HGE-a6b894","context":null,"enonce":"Which of the following are etiologies of painful splenomegaly?","item":"splenomeg","matiere":"HGE","propositions":[{"correct":true,"justification":"True, first cause to evoke in front of its gravity","idx":0,"proposition":"Splenic infarction"},{"correct":false,"justification":"Usually yes, but not all.","idx":1,"proposition":"All splenomegaly are painful"},{"correct":true,"justification":"True, sickle cell disease can be very painful","idx":2,"proposition":"Sickle-cell anemia"},{"correct":false,"justification":"Painless","idx":3,"proposition":"Peripheral hemolysis"},{"correct":false,"justification":"Painless","idx":4,"proposition":"Portal hypertension"}],"type":"custom"}
{"_id":"MSN-urg-c0f1ca","context":null,"enonce":"Which of the following are examinations to be carried out systematically in case of severe discomfort of the infant?","item":"MSN","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Capillary blood glucose"},{"correct":false,"justification":"Not systematic","idx":1,"proposition":"Ultrasound of fontanelles"},{"correct":true,"justification":"True","idx":2,"proposition":"Calcemia"},{"correct":true,"justification":"True, with QTc measurement","idx":3,"proposition":"ECG"},{"correct":false,"justification":"Apart from chest X-ray, no imaging examination to be performed systematically","idx":4,"proposition":"Whole body CT"}],"type":"custom"}
{"_id":"polytrauma-urg-4e0363","context":null,"enonce":"Which of the following proposals regarding the care of a burn victim are true?","item":"polytrauma","matiere":"urg","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Two-thirds of cases are domestic or leisure accidents"},{"correct":true,"justification":"True","idx":1,"proposition":"According to Wallace's rule of \"9\" the surface of a child's head corresponds to 17% of his body surface. "},{"correct":false,"justification":"False, 1 leg = 18%, so 2 legs = 36%","idx":2,"proposition":"According to Wallace's rule of \"9\" the area of both legs of an adult corresponds to 18% of his body surface. "},{"correct":true,"justification":"True","idx":3,"proposition":"Mortality associated with burns is nearly 28% for burns corresponding to more than 30% of the total body surface area"},{"correct":false,"justification":"False, J7","idx":4,"proposition":"Distinguishing a deep 2nd degree from a superficial 2nd degree is difficult before J1"}],"type":"custom"}
{"_id":"matraitanceped-sp-9ba8d2","context":null,"enonce":"Which of the following are risk factors for abuse?","item":"matraitanceped","matiere":"sp","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Precarious socio-economic level"},{"correct":true,"justification":"True","idx":1,"proposition":"Prematurity"},{"correct":false,"justification":"Hyposomnia","idx":2,"proposition":"Baby's hypersomnia"},{"correct":false,"justification":"Primiparity","idx":3,"proposition":"Multiple pregnancy"},{"correct":false,"justification":"Unwanted","idx":4,"proposition":"Highly anticipated pregnancy"}],"type":"custom"}
{"_id":"puberte-gyn-aba136","context":null,"enonce":"Which of the following are true?","item":"puberte","matiere":"gyn","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"In case of precocious puberty, imaging is essential: brain MRI if suspicion of central precocious puberty, imaging of the gonads if suspicion of peripheral precocious puberty."},{"correct":true,"justification":"True","idx":1,"proposition":"An increase in uterine body length > 35mm is a sign of estrogenic impregnation."},{"correct":false,"justification":"FALSE. Always make a bone age.","idx":2,"proposition":"Bone age is not systematic as part of an early puberty check-up"},{"correct":false,"justification":"Isolated precocious pubic hair is not synonymous with precocious puberty. It does not correspond to the pubertal activation of the gonadotropic axis but most often to the physiological increase in androgen production by the adrenal around the age of 8 years. BUT, it is a diagnosis of elimination, retained after evoking a pathological production of androgens of adrenal or gonadal origin.","idx":3,"proposition":"Isolated early pubic hair should not be explored"},{"correct":false,"justification":"False. We must think of a Kallman syndrome (which gives a delayed puberty of central origin by hypogonadotropic hypogonadism).                             Klinefelter syndrome gives it a delayed puberty of peripheral origin (although in reality it is more an appearance of pubertal signs without an increase in testicular volume).","idx":4,"proposition":"Faced with delayed puberty in boys, with a history of anosmia in the family, it is necessary to think of Klinefelter's syndrome."}],"type":"custom"}
{"_id":"constipation-HGE-60a619","context":null,"enonce":"Which of the following are true about laxatives?","item":"constipation","matiere":"HGE","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Osmotic laxatives draw water into colonic lumen"},{"correct":false,"justification":"Osmotic laxative","idx":1,"proposition":"The macrogol is an emolient"},{"correct":true,"justification":"True","idx":2,"proposition":"They are contraindicated in case of stenosis"},{"correct":true,"justification":"True","idx":3,"proposition":"Ballast laxatives may be responsible for bloating"},{"correct":false,"justification":"","idx":4,"proposition":"All propositions are true"}],"type":"custom"}
{"_id":"recomedic-therapeutique-64835e","context":null,"enonce":"Unless otherwise agreed, what is the duration of a patent for an originator pharmaceutical molecule?","item":"recomedic","matiere":"therapeutique","propositions":[{"correct":false,"justification":"False","idx":0,"proposition":"5 years"},{"correct":false,"justification":"False","idx":1,"proposition":"10 years"},{"correct":false,"justification":"False","idx":2,"proposition":"15 years"},{"correct":true,"justification":"True. Pharmaceutical patents are granted, like all other patents, for a period of 20 years from filing and subject to payment of annuities.","idx":3,"proposition":"20 years"},{"correct":false,"justification":"False","idx":4,"proposition":"25 years"}],"type":"custom"}
{"_id":"puberte-gyn-f1ac0b","context":null,"enonce":"Normal and physiological puberty Which of the following are true?","item":"puberte","matiere":"gyn","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"G5 corresponds to an adult testicular volume, i.e. between 20 and 25 ml."},{"correct":false,"justification":"False Sorry it sucks as a trap, it is losangic in men, triangular in women, but I have already been done during my clerkship.","idx":1,"proposition":"P5 corresponds to the adult aspect of the hairiness, ie triangular in men, losangic in women, extending to the root of the thighs."},{"correct":true,"justification":"True","idx":2,"proposition":"A mammary gland protruding beyond the surface of the areola classifies breast development as S3"},{"correct":true,"justification":"True","idx":3,"proposition":"As soon as there is a small breast bud with enlargement of the areola we can speak of breast development S2."},{"correct":true,"justification":"True","idx":4,"proposition":"G2 corresponds to a testicular volume between 4 and 6ml."}],"type":"custom"}
{"_id":"329-urg-7a23bd9e-4b78-4c2d-8fe9-1fed2dcc39bd","context":null,"enonce":"Which of the following propositions regarding compartment syndrome is true?","item":"polytrauma","matiere":"urg","propositions":[{"correct":false,"justification":"False. It is an immediate\/early complication that occurs within 24 hours. The development of unbearable pain at the site of the fracture is the diagnostic key to this complication.","idx":0,"proposition":"A. It is a late complication that can occur after fracture of a limb "},{"correct":false,"justification":"False false false !! The pulse is preserved. If they disappear, we should rather suspect acute ischemia of the limb ... or the very late stage of the compartment syndrome... that is, when the patient has lost his leg and is no longer in pain at all. So remember that \"PALOR\" and \"PULSELESSNESS\" are signs too late in the syndrome of the compartments","idx":1,"proposition":"Peripheral pulses are abolished"},{"correct":false,"justification":"False. The figure is correct: it is pathological if > 20 mmHg BUT the diagnosis is CLINICAL +++. So no need to make a pressure measurement to everyone","idx":2,"proposition":"The measurement of a pressure in the compartments > 20 mmHg is essential for diagnosis"},{"correct":true,"justification":"True! Nothing to say! ","idx":3,"proposition":"A discharge aponeurotomy is indicated within 6 hours"},{"correct":true,"justification":"True! It is related to a syndrome of the compartments of the forearm responsible for muscle retraction! Syndrome well to know that can be found in pediatrics when one performs poorly plasters (among others). \r\n\r\nAll this information can be found on page 343 of the last college of anesthesia resuscitation (not essential to read but it is free and online so it is the only one I have on hand","idx":4,"proposition":"Volkmann syndrome is responsible for a claw deformity of the hand "}],"type":"custom"}
{"_id":"Kcped-onco-e51d6b","context":null,"enonce":"Which of the following are true about nephroblastoma?","item":"Kcped","matiere":"onco","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"There is no specific tumor marker"},{"correct":true,"justification":"True","idx":1,"proposition":"LDH can be increased"},{"correct":false,"justification":"To the lung","idx":2,"proposition":"Nephroblastoma metastasizes mainly to the pancreas"},{"correct":false,"justification":"Asymptomatic for a very long time (such as kidney tumours in adults)","idx":3,"proposition":"Nephroblastoma is immediately symptomatic"},{"correct":false,"justification":"Especially children under 6 years old","idx":4,"proposition":"Nephroblastoma mainly affects adolescents"}],"type":"custom"}
{"_id":"185-immuno-f4c32ca1-8e89-4167-b528-cc62a2678d85","context":null,"enonce":"What are the first laboratory tests to order if variable common immunodeficiency is suspected?","item":"immunoD","matiere":"immuno","propositions":[{"correct":true,"justification":"True, notion of course to know because falls very often in MCQ","idx":0,"proposition":"Count - Complete blood count"},{"correct":false,"justification":"False, in 2nd intention","idx":1,"proposition":"Immunophenotyping of B lymphocytes"},{"correct":true,"justification":"True, notion of course to know because falls very often in MCQ","idx":2,"proposition":"Post-vaccination serology"},{"correct":true,"justification":"True, notion of course to know because falls very often in MCQ","idx":3,"proposition":"Weight determination of immunoglobulins"},{"correct":false,"justification":"False, in 2nd intention","idx":4,"proposition":"Determination of immunoglobulin G subclasses"}],"type":"custom"}
{"_id":"vomisst-HGE-a2e8fe","context":null,"enonce":"Which of the following are clinical signs of pyloric stenosis?","item":"vomisst","matiere":"HGE","propositions":[{"correct":false,"justification":"Free interval","idx":0,"proposition":"Vomiting from birth"},{"correct":true,"justification":"True","idx":1,"proposition":"Jet vomiting"},{"correct":false,"justification":"Never bilieux (stenosis upstream of the duodenum)","idx":2,"proposition":"Two-way vomiting"},{"correct":true,"justification":"True","idx":3,"proposition":"Vomiting in late postprandial"},{"correct":false,"justification":"Preserved appetite","idx":4,"proposition":"Anorexia"}],"type":"custom"}
{"_id":"FA-cardio-12e9f1","context":null,"enonce":"Which of the following are contraindications to direct oral anticoagulants (DOACs)?","item":"FA","matiere":"cardio","propositions":[{"correct":true,"justification":"True, or even clearance< 30 mL\/min\/1m73^2 for some molecules","idx":0,"proposition":"Severe renal impairment (clearance < 15 mL\/min\/1m73^2)"},{"correct":true,"justification":"True, need for VKA","idx":1,"proposition":"AF valves"},{"correct":true,"justification":"True","idx":2,"proposition":"Mitral narrowing"},{"correct":false,"justification":"No age limit","idx":3,"proposition":"Age > 80"},{"correct":false,"justification":"Not an IC","idx":4,"proposition":"Type 1 diabetes"}],"type":"custom"}
{"_id":"valeurspro-sp-078832","context":null,"enonce":"Which of the following are true?","item":"valeurspro","matiere":"sp","propositions":[{"correct":true,"justification":"True","idx":0,"proposition":"Sperm donation is non-anonymous and remunerated in Great Britain"},{"correct":true,"justification":"True","idx":1,"proposition":"Sperm donation is non-anonymous and remunerated in the US"},{"correct":false,"justification":"Anonymous and unpaid","idx":2,"proposition":"Sperm donation is non-anonymous and remunerated in France"},{"correct":false,"justification":"Non-anonymous","idx":3,"proposition":"Sperm donation is anonymous and remunerated in Great Britain"},{"correct":false,"justification":"Anonymous","idx":4,"proposition":"Sperm donation is non-anonymous and unpaid in France"}],"type":"custom"}
{"_id":"masseabdo-HGE-8958e3","context":null,"enonce":"What is the threshold of length of the hepatic arrow at which we can speak of hepatomegaly?","item":"masseabdo","matiere":"HGE","propositions":[{"correct":false,"justification":"The double ✌","idx":0,"proposition":"6 cm"},{"correct":false,"justification":"","idx":1,"proposition":"10 cm"},{"correct":true,"justification":"True","idx":2,"proposition":"12 cm"},{"correct":false,"justification":"","idx":3,"proposition":"15 cm"},{"correct":false,"justification":"","idx":4,"proposition":"24 cm"}],"type":"custom"}
{"_id":"securisation-sp-c838d7","context":null,"enonce":"Which of the following proposals are validating for CPD (Continuing Professional Development)?","item":"securisation","matiere":"sp","propositions":[{"correct":false,"justification":"Continuous Teamwork Improvement Program set up by the HAS in 2015 whose objective is to reduce EIAS","idx":0,"proposition":"PACT"},{"correct":true,"justification":"True","idx":1,"proposition":"RCP"},{"correct":true,"justification":"True","idx":2,"proposition":"RMM"},{"correct":true,"justification":"True","idx":3,"proposition":"Multi-professional protocols"},{"correct":false,"justification":"List of items essential to the smooth running of a procedure that allows a cross-checking of information","idx":4,"proposition":"Check lists"}],"type":"custom"}
{"_id":"coma-urg-d53de1","context":null,"enonce":"Which of the following proposals should be combated to avoid ACOS?","item":"coma","matiere":"urg","propositions":[{"correct":false,"justification":"On the contrary, it must be respected and hypotension avoided.","idx":0,"proposition":"Hypertension"},{"correct":true,"justification":"True","idx":1,"proposition":"Hypoxemia"},{"correct":true,"justification":"True","idx":2,"proposition":"Hypercapnia"},{"correct":true,"justification":"True","idx":3,"proposition":"Fever 🤒 "},{"correct":false,"justification":"We must fight bradycardia","idx":4,"proposition":"Tachycardia"}],"type":"custom"}
{"_id":"PF-neuro-948b59","context":null,"enonce":"Regarding facial paralysis among the following propositions, which one or which are true?","item":"PF","matiere":"neuro","propositions":[{"correct":false,"justification":"False, we are not in the situation of a stroke or the attack is located upstream of the decussation, here we are downstream so we will have a contralateral involvement.","idx":0,"proposition":"Central facial paralysis is often associated with contralateral hemiparesis\/hemiplegia"},{"correct":false,"justification":"False, the VII innervates the muscles of the face it is the IX and the X that innervate the muscles of the pharynx \/ larynx.","idx":1,"proposition":"In case of bilateral facial paralysis, the risk is suffocation by collapse of the muscles of the pharynx and the soft palate"},{"correct":false,"justification":"False, the treatment of facial paralysis is based on corticosteroid therapy and artificial drops","idx":2,"proposition":"Treatment of peripheral facial paralysis in frigore includes therapeutic abstention"},{"correct":true,"justification":"True. Clinically rare pathologies, but this notion falls all the time in MCQ.","idx":3,"proposition":"The causes of bilateral facial paralysis are: sarcoidosis, HIV, Melkerson Rosenthal syndrome, Guillain Barré and Lyme disease"},{"correct":true,"justification":"True, main danger to eliminate.","idx":4,"proposition":"In front of febrile facial paralysis it is essential to eliminate meningoradiculitis."}],"type":"custom"}
{"_id":"278-HGE-c939fccb-212d-490c-b3b2-99d25898395c","context":null,"enonce":"Which of the following propositions are true regarding pancreatic insufficiency, a consequence of chronic pancreatitis?","item":"pancreatitechr","matiere":"HGE","propositions":[{"correct":false,"justification":"Exocrine + endocrine (diabetes)","idx":0,"proposition":"She is exocrine only"},{"correct":false,"justification":"Late but mandatory","idx":1,"proposition":"This is an early complication"},{"correct":true,"justification":"True","idx":2,"proposition":"Diabetes can be insulin-dependent"},{"correct":true,"justification":"True","idx":3,"proposition":"It can be accompanied by steatorrhea"},{"correct":true,"justification":"True, clear stools, putty, very foul-smelling, floating, staining toilet paper like a greasy","idx":4,"proposition":"Stools are clear"}],"type":"custom"}
{"_id":"obesite-endoc-5c34d48","context":null,"enonce":"Which of these proposals are complications of obesity?","item":"obesite","matiere":"endoc","propositions":[{"idx":0,"correct":true,"proposition":"None of these proposals","justification":"True"},{"idx":1,"correct":false,"proposition":"Type 1 diabetes","justification":"Type 2"},{"idx":2,"correct":false,"proposition":"Low blood pressure","justification":"HTA"},{"idx":3,"correct":false,"proposition":"Alcoholic pancreatitis","justification":"Lithiatic pancreatitis"},{"idx":4,"correct":false,"proposition":"Haematuria","justification":"Two types of kidney damage secondary to obesity: FSH and proteinuria"}],"type":"custom"}
{"_id":"163-infectio-eb4d28e9-ae80-4401-aa99-74052a2cb65b","context":null,"enonce":"What are the exact proposals regarding the hepatitis B virus and its natural history? ","item":"VH","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"It is an enveloped double-stranded RNA virus. ","justification":"False. Only virus with DNA "},{"idx":1,"correct":true,"proposition":"It may be responsible for the development of HCC on healthy liver. ","justification":"True"},{"idx":2,"correct":false,"proposition":"Chronic hepatitis B is a reportable disease and requires routine antiviral treatment ","justification":"False. Acute hepatitis is an MDO but not the chronic form. In addition, treatment is indicated according to certain situations and is therefore not systematic. "},{"idx":3,"correct":false,"proposition":"The risk of fulminant hepatitis is rare and occurs especially in pregnant women. ","justification":"False. Risk of HBV-related fulminant hepatitis = 1%. It is HEV that is at risk of fulminant hepatitis in pregnant women. "},{"idx":4,"correct":false,"proposition":"90-95% of acute hepatitis progress to cure, which is characterized biologically by: Ag Hbs -; ac anti Hbc - and ac anti Hbs + ","justification":"False. It is true that 90% of acute HBV are of favorable evolution but the serological profile corresponds to Ag Hbs -, ac anti Hbc + (the patient has been in contact with the virus!!) and ac anti Hbs +.   The serological profile given in the question corresponds to a vaccination."}],"type":"custom"}
{"_id":"meningite-infectio-eea87e9","context":null,"enonce":"Which germs are gram-positive cocci in clusters?","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Staphylococcus aureus","justification":"True, remember all Staph for ECN"},{"idx":1,"correct":true,"proposition":"Staphylococcus Epidermis","justification":"True, remember all Staph for ECN"},{"idx":2,"correct":false,"proposition":"Pneumococcus ","justification":"Diplococcus is a streptococcus, so chains!"},{"idx":3,"correct":false,"proposition":"Enterococcus fæcalis","justification":"Short chain"},{"idx":4,"correct":false,"proposition":"Enterococcus faecium","justification":"Short chain"}],"type":"custom"}
{"_id":"PR-rhumato-0614629","context":null,"enonce":"Which joints are usually affected in rheumatoid arthritis?","item":"PR","matiere":"rhumato","propositions":[{"idx":0,"correct":true,"proposition":"Proximal interphalangeal","justification":"True"},{"idx":1,"correct":false,"proposition":"Distal interphalangeal","justification":"False, IPDs are joints usually respected by rheumatoid arthritis"},{"idx":2,"correct":true,"proposition":"Metacarpophalangeal","justification":"True"},{"idx":3,"correct":true,"proposition":"Ankles","justification":"True"},{"idx":4,"correct":true,"proposition":"Metatarsophalangeal","justification":"True"}],"type":"custom"}
{"_id":"MM-onco-b7c0882","context":null,"enonce":"You receive Mr IZUKU, Midoriya, 76 years old, whom you follow for a suspicion of multiple myeloma of the bones. You want to make the diagnosis, via a myelogram. But your patient, worried, asks you many questions about this examination. What are your answers?","item":"MM","matiere":"onco","propositions":[{"idx":0,"correct":false,"proposition":"A myelogram is a biopsy of the bone marrow","justification":"False, this is a bone marrow smear, not a biopsy"},{"idx":1,"correct":false,"proposition":"The myelogram is most often very painful and requires locoregional anesthesia before its realization","justification":"False, the myelogram is most often unpleasant, but it only requires local anesthesia by xylocaine or EMLA patch"},{"idx":2,"correct":false,"proposition":"A myelogram with a threshold greater than 20% plasma cells is defined as pathological and affirms the diagnosis of multiple myeloma","justification":"False, the 20% threshold is for acute leukemia, it's 10% for plasma cells in multiple myeloma"},{"idx":3,"correct":false,"proposition":"Sternal myelogram is most often contraindicated in patients who have previously had a sternal myelogram","justification":"False, in theory several myelograms can be performed in sternal"},{"idx":4,"correct":true,"proposition":"If the myelogram is not contributive, an osteomedullary biopsy will be done","justification":"True, this is the case when the marrow is very poor"}],"type":"custom"}
{"_id":"noduleTh-endoc-b1dbd67","context":null,"enonce":"What ultrasound arguments of nodules would be in favor of malignancy?","item":"noduleTh","matiere":"endoc","propositions":[{"idx":0,"correct":true,"proposition":"Hypoechoic","justification":"True"},{"idx":1,"correct":false,"proposition":"Lack of vascularization ","justification":"Rather benign"},{"idx":2,"correct":true,"proposition":"Irregular contours","justification":"True"},{"idx":3,"correct":true,"proposition":"Incomplete halo","justification":"True"},{"idx":4,"correct":true,"proposition":"High TI-RADS classification ","justification":"True"}],"type":"custom"}
{"_id":"appendicite-HGE-f31b9c0","context":null,"enonce":"What are the differential diagnoses of appendicitis?","item":"appendicite","matiere":"HGE","propositions":[{"idx":0,"correct":true,"proposition":"Right colonic tumour","justification":"True"},{"idx":1,"correct":true,"proposition":"Epiploic fringe torsion","justification":"True"},{"idx":2,"correct":true,"proposition":"mesenteric adenotillitis","justification":"True"},{"idx":3,"correct":false,"proposition":"Splenic infarction","justification":"It's not the good side 🤭"},{"idx":4,"correct":true,"proposition":"ileoccolic Crohn's disease or ulcerative colitis","justification":"True"}],"type":"custom"}
{"_id":"meningite-infectio-c47da90","context":null,"enonce":"What are Enterobacteriaceae?","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Helicobacter pylori","justification":""},{"idx":1,"correct":true,"proposition":"E. coli","justification":"True"},{"idx":2,"correct":true,"proposition":"Proteus mirabilis","justification":"True"},{"idx":3,"correct":true,"proposition":"Salmonella","justification":"True"},{"idx":4,"correct":false,"proposition":"Pseudomonas aeruginosa","justification":"Enterobacteras are: \n- E. coli\n-Klebsiella\n- Proteus mirabilis\n-Salmonella\n-Shigella\n- Yersinia"}],"type":"custom"}
{"_id":"antiinf-infectio-f6c6b0c","context":null,"enonce":"Which ones are dependent time?","item":"antiinf","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Penicillins","justification":"True"},{"idx":1,"correct":true,"proposition":"C3G","justification":"True"},{"idx":2,"correct":true,"proposition":"Carbapenems","justification":"True"},{"idx":3,"correct":true,"proposition":"Vancomycins","justification":"True"},{"idx":4,"correct":true,"proposition":"C2G","justification":"True"}],"type":"custom"}
{"_id":"palu-infectio-293b150","context":null,"enonce":"What medications can you prescribe for malaria chemoprophylaxis?","item":"palu","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Atovaquone-proguanil","justification":"True"},{"idx":1,"correct":true,"proposition":"Mefloquine","justification":"True"},{"idx":2,"correct":true,"proposition":"Doxycyline","justification":"True"},{"idx":3,"correct":false,"proposition":"Lumefantrine artemeter","justification":"Cure"},{"idx":4,"correct":false,"proposition":"Artesunate","justification":"Cure"}],"type":"custom"}
{"_id":"vaccin-infectio-9534fa6","context":null,"enonce":"What vaccinations can be used post-exposure?","item":"vaccin","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Anti-hepatitis B","justification":"True"},{"idx":1,"correct":false,"proposition":"Influenza","justification":""},{"idx":2,"correct":false,"proposition":"BCG","justification":""},{"idx":3,"correct":true,"proposition":"Anti-hepatitis A","justification":"within 14 days of contact"},{"idx":4,"correct":true,"proposition":"Anti-measles","justification":"True within 3 days of contact"}],"type":"custom"}
{"_id":"vaccin-infectio-9f0436b","context":null,"enonce":"What vaccine is administered intradermally?","item":"vaccin","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"BCG","justification":"True"},{"idx":1,"correct":false,"proposition":"HAV","justification":"IM or SC"},{"idx":2,"correct":false,"proposition":"MMR","justification":"IM or SC"},{"idx":3,"correct":false,"proposition":"Dtp","justification":"IM or SC"},{"idx":4,"correct":false,"proposition":"Whooping cough","justification":"IM or SC"}],"type":"custom"}
{"_id":"vaccin-infectio-b16f763","context":null,"enonce":"What vaccinations are mandatory for healthcare staff?","item":"vaccin","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Measles","justification":"recommended"},{"idx":1,"correct":false,"proposition":"Influenza","justification":"recommended"},{"idx":2,"correct":true,"proposition":"DTP","justification":""},{"idx":3,"correct":false,"proposition":"BCG","justification":"No longer since March 1, 2019"},{"idx":4,"correct":true,"proposition":"Hepatitis B","justification":"True"}],"type":"custom"}
{"_id":"vaccin-infectio-b53e07a","context":null,"enonce":"What are the indications for the BCG vaccine?","item":"vaccin","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"child born in endemic countries","justification":"True"},{"idx":1,"correct":true,"proposition":"parent from endemic countries","justification":"True"},{"idx":2,"correct":true,"proposition":"child residing in Île-de-France","justification":"True"},{"idx":3,"correct":false,"proposition":"child residing in Guadeloupe","justification":"Child residing in Île-de-France, French Guiana or Mayotte"},{"idx":4,"correct":false,"proposition":"child residing in Reunion Island","justification":""}],"type":"custom"}
{"_id":"arthrose-rhumato-5dddba6","context":null,"enonce":"What are the radiographic cardinal signs of osteoarthritis? ","item":"arthrose","matiere":"rhumato","propositions":[{"idx":0,"correct":true,"proposition":"Pinch of joint space ","justification":"True. The radiological cardinal signs of osteoarthritis are POGO: Localized joint pinching, Osteophytosis, Subchondral geodes, Condensing osteosclerosis "},{"idx":1,"correct":false,"proposition":"Bone erosions ","justification":"False, no bone erosions in osteoarthritis! They are found in RP for example"},{"idx":2,"correct":true,"proposition":"Osteophytosis","justification":"True"},{"idx":3,"correct":true,"proposition":"Subchondral geodes ","justification":"True"},{"idx":4,"correct":true,"proposition":"Condensing osteosclerosis ","justification":"True"}],"type":"custom"}
{"_id":"meningite-infectio-f8de611","context":null,"enonce":"Which meningitis should benefit from corticosteroid therapy?","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"Meningococcal meningitis in children","justification":"These are pneumococcal meningitis in all cases, and:\n- H. influenzae meningitis in children\n- N. meningitidis (meningococcus) meningitis in adults"},{"idx":1,"correct":true,"proposition":"Haemophilus influenzae meningitis in children","justification":""},{"idx":2,"correct":false,"proposition":"Meningococcal meningitis in children and adults","justification":""},{"idx":3,"correct":true,"proposition":"Pneumococcal meningitis in children","justification":""},{"idx":4,"correct":true,"proposition":"Pneumococcal meningitis in adults","justification":""}],"type":"custom"}
{"_id":"meningite-infectio-305d0f9","context":null,"enonce":"You are an intern in the emergency department of a peripheral CH. While you were quietly watching the latest episode of Squid Game on your brand new phone (now that you have a real salary, you can indeed treat yourself to small pleasures), you are called by the nurse to do a lumbar puncture to Theo, 2 years old, who has a fever of 40.5 ° C, a very flexible neck. The fluid is cloudy and the anathomopathology intern (who happens to be one of your best friends in the day school) calls you to announce the presence of live Gram-negative diplococci. Which propositions are true?","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"It is not a germ classically responsible for meningitis at its age","justification":"True, it is rather pneumococcus and H. influenzae. Neisseria meningitidis predominates between 18 and 25 years."},{"idx":1,"correct":false,"proposition":"He does not have meningitis because his neck is flexible","justification":"False, ultra false, and probably zero! In children, neck stiffness is often missing (have you ever seen a 2-year-old? It's super flexible, isn't it?). Don't worry if you ticked it, that's how we all 😊 learn"},{"idx":2,"correct":false,"proposition":"Treatment with antibiotic + corticosteroid therapy is initiated","justification":"False, in children it is only in pneumococcal and H. influenzae meningitis that corticosteroids are put"},{"idx":3,"correct":true,"proposition":"He has meningitis caused by Neisseiria meningitdis","justification":"True, at NEC the only gram-negative diplococci are meningococci"},{"idx":4,"correct":false,"proposition":"He has Haemophilus influenzae meningitis","justification":"False, it is a Gram-negative bacillus"}],"type":"custom"}
{"_id":"meningite-neuro-419032c","context":null,"enonce":"What are the complications of post-PL syndrome?","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"correct":true,"proposition":"Cerebral venous thrombosis","justification":"True, these are the two complications to know about."},{"idx":1,"correct":false,"proposition":"Blurred vision","justification":"False, it is the semiology of post-PL syndrome (blurred vision, sound distortion with tinnitus and decreased hearing acuity, nausea, vomiting, dizziness, orthostatic headache) and not its complication"},{"idx":2,"correct":true,"proposition":"Subdural hematoma","justification":"True"},{"idx":3,"correct":false,"proposition":"Dizziness","justification":""},{"idx":4,"correct":false,"proposition":"Sound distortion","justification":""}],"type":"custom"}
{"_id":"VIH-infectio-375444a","context":null,"enonce":"What is the treatment of primary Toxoplasma gondii infection in the immunocompetent, in the general case (without chorioretinitis)?","item":"VIH","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":" pyrimethamine + folinic acid + sulfadiazine","justification":"Cerebral toxoplasmosis, disseminated in the immunocompromised"},{"idx":1,"correct":false,"proposition":" pyrimethamine + folinic acid + sulfadiazine + prednisone ","justification":"Treatment of chorioretinitis "},{"idx":2,"correct":false,"proposition":"spiramycin","justification":"in pregnant women"},{"idx":3,"correct":false,"proposition":" pyrimethamine-sulfadoxine + folinic acid","justification":"in pregnant women + fetal involvement"},{"idx":4,"correct":true,"proposition":"no treatment required","justification":"True"}],"type":"custom"}
{"_id":"meningite-infectio-346ea82","context":null,"enonce":"What etiologies should be suspected in hypoglycorachic lymphocytic meningitis","item":"meningite","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Koch's bacillus","justification":"True"},{"idx":1,"correct":false,"proposition":"Pneumococcus","justification":"Purulent meningitis"},{"idx":2,"correct":true,"proposition":"Listeria","justification":"True"},{"idx":3,"correct":true,"proposition":"Cryptococcus neoformans","justification":"True, it will also be necessary to evoke carcinomatous meningitis if the terrain lends itself to it"},{"idx":4,"correct":false,"proposition":"HSV","justification":"Normoglycorachic lymphocytic meningitis"}],"type":"custom"}
{"_id":"valvuloP-cardio-6217061","context":null,"enonce":"What are the 3 cardinal signs in symptomatic aortic stricture? ","item":"valvuloP","matiere":"cardio","propositions":[{"idx":0,"correct":true,"proposition":"Stress syncope. ","justification":"True: the core can no longer push hard enough to adapt to peripheral O2 needs because of RAC, so lack of O2, so syncope"},{"idx":1,"correct":false,"proposition":"HTA. ","justification":"False, hypertrophy of the VG who fights against the RAC, but suddenly the tension does not increase ..."},{"idx":2,"correct":true,"proposition":"Stress angina. ","justification":"True, cf 1"},{"idx":3,"correct":false,"proposition":"Headaches. ","justification":"False. "},{"idx":4,"correct":true,"proposition":"Dyspnea of effort. ","justification":"True, cf 1"}],"type":"custom"}
{"_id":"183-immuno-4237f229-eac1-4230-a154-15e6219dcfbc","context":null,"enonce":"Regarding chronic urticaria, what are the exact proposal(s)?","item":"allergiecut","matiere":"immuno","propositions":[{"idx":0,"correct":false,"proposition":"There are multiple causes of chronic urticaria, including stress","justification":"False, stress does not induce hives but can maintain it! "},{"idx":1,"correct":false,"proposition":"A hives that occurs after high heat is probably bradykinic urticaria","justification":"False, it's cholinergic urticaria!"},{"idx":2,"correct":true,"proposition":"In the context of cold urticaria, the ice cube test must be done in a hospital setting to be able to react in case of anaphylactic shock","justification":"True! As surprising as it may seem, it is a provocation test, so it can lead to anaphylactic shock."},{"idx":3,"correct":true,"proposition":"Chronic urticaria may reveal hypothyroidism","justification":"True, this is why we will look for anti-thyroperoxidase antibodies in case of resistance to symptomatic treatment"},{"idx":4,"correct":false,"proposition":"The reference treatment of urticaria is based on local corticosteroid therapy","justification":"False! On antihistamines, urticaria being mediated by histamine"}],"type":"custom"}
{"_id":"coqueluche-infectio-4f655d2","context":null,"enonce":"About pertussis vaccination: ","item":"coqueluche","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"The 1st dose is carried out at 2 months then 4 and 11 months and at 6 years. ","justification":"True. "},{"idx":1,"correct":false,"proposition":"People in regular close and lasting contact with an infant in the first 6 months do not respond to the strategy of cocooning","justification":"False, verification and, if necessary, vaccination catch-up. "},{"idx":2,"correct":false,"proposition":"Vaccination confers longer immunity than natural immunity acquired after pertussis. ","justification":"False, vaccine: 5-10 years VS natural immunity: 10-15 years. "},{"idx":3,"correct":true,"proposition":"Vaccination does not protect for life. ","justification":"True, hence the many reminders made throughout life. "},{"idx":4,"correct":true,"proposition":"Pertussis vaccine is an acellular vaccine. ","justification":"True. "}],"type":"custom"}
{"_id":"asthme-immuno-9b8fc42","context":null,"enonce":"What are the treatments for allergic rhinitis? ","item":"asthme","matiere":"immuno","propositions":[{"idx":0,"correct":false,"proposition":"Nasal vasoconstrictors ","justification":"Strongly discouraged, because there is always a systemic passage so risk of angina"},{"idx":1,"correct":true,"proposition":"Saline nasal lavage ","justification":"Equivalent of newborn ORDs"},{"idx":2,"correct":true,"proposition":"Systemic antihistamines","justification":""},{"idx":3,"correct":true,"proposition":"Inhaled corticosteroids","justification":""},{"idx":4,"correct":true,"proposition":"Smoking cessation ","justification":""}],"type":"custom"}
{"_id":"adenomehypoP-endoc-2ac25df","context":null,"enonce":"What biological tests can you perform to look for hypersecretion of GH?","item":"adenomehypoP","matiere":"endoc","propositions":[{"idx":0,"correct":false,"proposition":"The insulin hypoglycemia test ","justification":"The reference test for the detection of corticotropic deficiency is insulin hypoglycemia (rank C)"},{"idx":1,"correct":true,"proposition":"Oral Induced Hyperglycemia Test (also called OPGH) ","justification":"True, a sharp decrease in GH is expected"},{"idx":2,"correct":true,"proposition":"The determination of IGF1","justification":"True, stable secretion over the day"},{"idx":3,"correct":false,"proposition":"GH determination","justification":"Very difficult to do and interpret (nocturnal and pulsatile secretion)"},{"idx":4,"correct":false,"proposition":"Somatostatin testing","justification":"We never see this dosage (neither at the ECN, nor in practice)"}],"type":"custom"}
{"_id":"recherche-sp-13662fb","context":null,"enonce":"In a randomized clinical trial, patients' consent is collected by: ","item":"recherche","matiere":"sp","propositions":[{"idx":0,"correct":false,"proposition":"The promoter","justification":""},{"idx":1,"correct":true,"proposition":"The investigator","justification":"True"},{"idx":2,"correct":false,"proposition":"the attending physician","justification":""},{"idx":3,"correct":false,"proposition":"The Reception Nurse","justification":""},{"idx":4,"correct":false,"proposition":"the head of department","justification":""}],"type":"custom"}
{"_id":"recherche-sp-e179062","context":null,"enonce":"In a randomized investigator clinical trial:","item":"recherche","matiere":"sp","propositions":[{"idx":0,"correct":false,"proposition":"It is a legal person","justification":"It is a natural person"},{"idx":1,"correct":true,"proposition":"It is a doctor most often","justification":"True"},{"idx":2,"correct":true,"proposition":"It is the guarantor of the protection of persons","justification":"True"},{"idx":3,"correct":true,"proposition":"It is the guarantor of the quality of care","justification":"True"},{"idx":4,"correct":true,"proposition":"It must above all respect the ethical rules and give priority to care over research","justification":"True"}],"type":"custom"}
{"_id":"epilepsie-neuro-5e3b9bb","context":null,"enonce":"What is the definition of a clonic crisis?","item":"epilepsie","matiere":"neuro","propositions":[{"idx":0,"correct":false,"proposition":"Sustained segmental muscle contractions","justification":""},{"idx":1,"correct":true,"proposition":"Repetitive and rhythmic segmental muscle twitches","justification":"True"},{"idx":2,"correct":false,"proposition":"Contraction of agonist and antagonist muscles, alone or in bursts","justification":""},{"idx":3,"correct":false,"proposition":"Loss of consciousness","justification":""},{"idx":4,"correct":false,"proposition":"Loss of contact","justification":""}],"type":"custom"}
{"_id":"meningite-neuro-0c40cfe","context":null,"enonce":"Which antibiotics have poor diffusion in the CSF?","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"correct":true,"proposition":"Amoxicillin","justification":""},{"idx":1,"correct":true,"proposition":"gentamicin","justification":""},{"idx":2,"correct":true,"proposition":"azythromycin","justification":""},{"idx":3,"correct":true,"proposition":"doxycycline","justification":""},{"idx":4,"correct":true,"proposition":"C3G","justification":"C3G diffuses very poorly in the CSF, like all other treatments, because the blood-brain barrier is formidable. However, unlike most other antibiotics, this poor diffusion can be compensated for by increasing the doses, all without being toxic. Hence the notion of meningeal dosage:) p277 of the Pilly of 2021"}],"type":"custom"}
{"_id":"meningite-neuro-9692edb","context":null,"enonce":"Mr. Tunik, 65, is hospitalized for the first time in psychiatry for a megalomaniac delirium that has lasted for a few months and worsens. In front of this first episode, you obviously asked for brain imaging that finds multiple cerebral infarctions. On clinical examination, you will find a decrease in visual and auditory acuity, an abolition of the photomotor reflex but a preservation of pupillary motility during convergent accommodation, and elements that seem compatible with frontal dementia.\nThe patient reports intense shooting pains of the limbs. You find abolished ROTs and frank ataxia.\nWhat is the most unifying diagnosis?","item":"meningite","matiere":"neuro","propositions":[{"idx":0,"correct":false,"proposition":"Syndrome de Korsakoff","justification":"Not the table at all, "},{"idx":1,"correct":false,"proposition":"Vascular dementia","justification":"It is a diagnosis of elimination"},{"idx":2,"correct":true,"proposition":"Neurosyphillis","justification":"Exactly! We find the sign of Argyll-Robertson (abolition of the photomotor reflex but preservation of pupillary motility during convergent accomodation), tabès (posterior cordal degeneration giving ataxia, areflexia, and shooting pain of the limbs), multiple infarctions related to angiitis, and frontal dementia with megalomania"},{"idx":3,"correct":false,"proposition":"Lyme meningitis","justification":"Not at all"},{"idx":4,"correct":false,"proposition":"NMDA limbic encephalitis","justification":"It does give psychiatric pictures, but finally, this patient is not very psychiatric."}],"type":"custom"}
{"_id":"RCIU-gyn-729ed7e","context":null,"enonce":"Regarding the Harmonious IUGR:","item":"RCIU","matiere":"gyn","propositions":[{"idx":0,"correct":false,"proposition":"It represents 80% of IUGR","justification":"This is the case with disharmonious IUGR"},{"idx":1,"correct":false,"proposition":"The main cause is vascular","justification":"This is the case with disharmonious IUGR"},{"idx":2,"correct":true,"proposition":"This type of IUGR appears earlier","justification":"True, in Q1"},{"idx":3,"correct":true,"proposition":"It is poor prognosis for size","justification":"True, most newborns and adults will have a short stature."},{"idx":4,"correct":true,"proposition":"It is a IUGR that is, most often, constitutional.","justification":"True, genetic cause ++ (Trisomy 13 or 18)"}],"type":"custom"}
{"_id":"IRespA-urg-03ec16f","context":null,"enonce":"What are the different clinical signs of bankruptcy to look for in favor of DRA?","item":"IRespA","matiere":"urg","propositions":[{"idx":0,"correct":false,"proposition":"Superficial polypnea","justification":"Signs of struggle"},{"idx":1,"correct":false,"proposition":"Active abdominal exhalation","justification":"Signs of struggle"},{"idx":2,"correct":false,"proposition":"Recruitment of accessory respiratory muscles","justification":"Signs of struggle"},{"idx":3,"correct":true,"proposition":"Paradoxical abdominal breathing","justification":"= thoraco-abdominal sway"},{"idx":4,"correct":true,"proposition":"Hypoxemia with cyanosis","justification":""}],"type":"custom"}
{"_id":"PNO-urg-4a57a5b","context":null,"enonce":"When is pleurodesis offered?","item":"PNO","matiere":"urg","propositions":[{"idx":0,"correct":true,"proposition":"Recurrence of PNO","justification":"The only 2 indications that remain in the CEP 2021 are: Recurrence of persistent PNO or PNO after 3-5 days of drainage"},{"idx":1,"correct":true,"proposition":"Persistent PNO after 3-5 days of drainage","justification":""},{"idx":2,"correct":false,"proposition":"Bilateral NOPs","justification":""},{"idx":3,"correct":false,"proposition":"Compressive PNO","justification":""},{"idx":4,"correct":false,"proposition":"PNO with hemothorax","justification":""}],"type":"custom"}
{"_id":"polytrauma-urg-99a316e","context":null,"enonce":"The lethal triad of severe traumatized includes:","item":"polytrauma","matiere":"urg","propositions":[{"idx":0,"correct":true,"proposition":"hypothermia","justification":""},{"idx":1,"correct":true,"proposition":"coagulopathy","justification":""},{"idx":2,"correct":true,"proposition":"acidosis","justification":"It is therefore necessary to detect and fight against these three elements from the beginning of the management of a severely traumatized patient"},{"idx":3,"correct":false,"proposition":"Alkalosis","justification":""},{"idx":4,"correct":false,"proposition":"fever","justification":""}],"type":"custom"}
{"_id":"IRC-nephro-7eae892","context":null,"enonce":"What arguments are in favor of a glomerular origin of chronic renal failure? ","item":"IRC","matiere":"nephro","propositions":[{"idx":0,"correct":true,"proposition":"Significant proteinuria made of albumin ","justification":"True"},{"idx":1,"correct":true,"proposition":"Early high blood pressure ","justification":"True, a late hypertension would rather be in favor of an interstitial origin "},{"idx":2,"correct":false,"proposition":"Moderate proteinuria","justification":"False, rather in favor of an interstitial origin "},{"idx":3,"correct":false,"proposition":"Germ-free leukocyturia ","justification":"False, rather in favor of an interstitial origin "},{"idx":4,"correct":false,"proposition":"Context of recurrent upper urinary tract infections","justification":"False, rather in favor of an interstitial origin "}],"type":"custom"}
{"_id":"tbiono-nephro-8325df8","context":null,"enonce":"Which test differentiates between central diabetes insipidus and nephrogenic diabetes insipidus? (one or more exact propositions)  ","item":"tbiono","matiere":"nephro","propositions":[{"idx":0,"correct":false,"proposition":"The water restriction test","justification":"Difference between potomania and diabetes insipidus"},{"idx":1,"correct":false,"proposition":"GH determination","justification":""},{"idx":2,"correct":false,"proposition":"TSH testing","justification":""},{"idx":3,"correct":false,"proposition":"The urinary ionogram","justification":"It will be the same whatever the cause"},{"idx":4,"correct":true,"proposition":"DHA test (Minirin)","justification":"True. If diabetes insipidus is central: polyuria will stop."}],"type":"custom"}
{"_id":"RCIU-gyn-fe4f66e","context":null,"enonce":"What are the etiologies of a harmonious IUGR?","item":"RCIU","matiere":"gyn","propositions":[{"idx":0,"correct":true,"proposition":"Genetics ","justification":"True"},{"idx":1,"correct":true,"proposition":"Chromosomal ","justification":"True"},{"idx":2,"correct":true,"proposition":"CMV ","justification":"True"},{"idx":3,"correct":false,"proposition":"Vascular cause","justification":"Disharmonious ++"},{"idx":4,"correct":false,"proposition":"All propositions are true","justification":""}],"type":"custom"}
{"_id":"antithrombotiques-therapeutique-cc19a0b","context":null,"enonce":"Regarding UFHs:","item":"antithrombotiques","matiere":"therapeutique","propositions":[{"idx":0,"correct":true,"proposition":" They should not be prescribed with other blood thinners","justification":"They are often introduced at the same time as VKAs to relay 😉"},{"idx":1,"correct":false,"proposition":"They can be taken orally (per os)","justification":"Only by IV or SC"},{"idx":2,"correct":false,"proposition":"They work by inhibiting antithrombin","justification":"They work by inhibiting procoagulant factors: factors II and X"},{"idx":3,"correct":false,"proposition":"Renal failure is a contraindication to their use","justification":"No, unlike LMWH (which is contraindicated in GFR < 60 = moderate CKD)."},{"idx":4,"correct":true,"proposition":"They can be antagonized by protamine sulfate","justification":"They have an antidote and that's great! 🙌🙌 (unlike AOD for example)"}],"type":"custom"}
{"_id":"AOMI-cardio-89ac32f","context":null,"enonce":"A murmur on an arterial path translates a stenosis of more than:","item":"AOMI","matiere":"cardio","propositions":[{"idx":0,"correct":true,"proposition":"There is no correlation","justification":""},{"idx":1,"correct":false,"proposition":"60%","justification":""},{"idx":2,"correct":false,"proposition":"80%","justification":""},{"idx":3,"correct":false,"proposition":"20%","justification":""},{"idx":4,"correct":false,"proposition":"90%","justification":""}],"type":"custom"}
{"_id":"IST-infectio-0fe75f2","context":null,"enonce":"Which of the following are correct about syphilis? (one or more answers are correct)","item":"IST","matiere":"infectio","propositions":[{"idx":0,"correct":false,"proposition":"The standard of care is based on penicillin M","justification":"penicillin G"},{"idx":1,"correct":true,"proposition":"Syphilitic posterior uveitis is treated as neurosyphilis","justification":"That is to say with 2 weeks of peniage G IV"},{"idx":2,"correct":false,"proposition":"syphilis is said to be early when it is less than 6 months old","justification":"less than one year old"},{"idx":3,"correct":false,"proposition":"Syphilitic chancre is classically painful","justification":"classically painless"},{"idx":4,"correct":false,"proposition":"Incubation is 3 to 5 days","justification":"about 3 weeks (long incubation)"}],"type":"custom"}
{"_id":"IST-infectio-1898d84","context":null,"enonce":"Which of the following are symptoms or signs that can be found during syphilis? (one or more answers are correct)","item":"IST","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Circumscribed alopecia","justification":""},{"idx":1,"correct":true,"proposition":"Roseola","justification":""},{"idx":2,"correct":true,"proposition":"Posterior uveitis","justification":"Treated then as neurosyphilis"},{"idx":3,"correct":false,"proposition":"Generalized pruritus","justification":"This is not a classic attack"},{"idx":4,"correct":false,"proposition":"Bilateral and symmetrical parotitis","justification":"This is rather found in case of viruses with glandular tropism, such as mumps"}],"type":"custom"}
{"_id":"IU-infectio-a0c2b4c","context":null,"enonce":"What is the most common germ in urinary tract infections? (only one answer expected)","item":"IU","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"E. coli","justification":"90%"},{"idx":1,"correct":false,"proposition":"Proteus Mirabilis","justification":"2nd"},{"idx":2,"correct":false,"proposition":"Staphylococcus saprophyticus","justification":"3rd, in young women ++, no nitrites at BU, treatment with nitrofurantoin 5J (CI if IR)"},{"idx":3,"correct":false,"proposition":"Klebsielle ","justification":"Nosocomial ++"},{"idx":4,"correct":false,"proposition":"Pseudomonas æruginosa","justification":"Possible but rare"}],"type":"custom"}
{"_id":"IU-infectio-d7bd0f8","context":null,"enonce":"What is the case, in humans, where antibiotic prophylaxis of urinary tract infection is indicated?","item":"IU","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"Transrectal prostate biopsies","justification":""},{"idx":1,"correct":false,"proposition":"Urethral probing","justification":""},{"idx":2,"correct":false,"proposition":"Placement of a JJ probe","justification":""},{"idx":3,"correct":false,"proposition":"Nephrectomy for hemostasis","justification":""},{"idx":4,"correct":false,"proposition":"Suprapubic catheter catheter","justification":""}],"type":"custom"}
{"_id":"IU-infectio-ea017e7","context":null,"enonce":"What is the probabilistic first-line treatment for acute cystitis at risk of complication in a renal failure patient with stage 4 CKD?","item":"IU","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"fosfomycin-trometamol","justification":"Second-line treatment if nitrofurantoin possible"},{"idx":1,"correct":false,"proposition":"nitrofurantoin ","justification":"Nitrofurantoin is contraindicated if GFR <30 (stage 4 CRM = GFR between 15 and 30)"},{"idx":2,"correct":false,"proposition":"Amoxicillin","justification":""},{"idx":3,"correct":false,"proposition":"Pivmecillinam","justification":""},{"idx":4,"correct":false,"proposition":"probabilistic treatment is never done","justification":"We prefer to wait for the susceptibility test, but sometimes the symptoms are very disabling. In this case, we adapt secondarily."}],"type":"custom"}
{"_id":"coqueluche-infectio-5655ddb","context":null,"enonce":"About the pertussis clinic, indicate the true propositions: ","item":"coqueluche","matiere":"infectio","propositions":[{"idx":0,"correct":true,"proposition":"There is a cough in paroxysmal fits with difficulty of inspiratory or chronic spasmodic recovery. ","justification":"True. "},{"idx":1,"correct":false,"proposition":"Fever is almost always present. ","justification":"NO fever in whooping cough! "},{"idx":2,"correct":false,"proposition":"There are 3 phases of evolution in order: fifth, catarrh, convalescence. ","justification":"False, catarrh then fifth, then convalescence. "},{"idx":3,"correct":true,"proposition":"The cough found in whooping cough can also be called \"rooster crow\". ","justification":"True, rooster song in the COQueluche. "},{"idx":4,"correct":false,"proposition":"It only affects infants. ","justification":"False, all ages possibly. "}],"type":"custom"}
{"_id":"HBP-uro-ac3816f","context":null,"enonce":"In benign prostatic hyperplasia, what is the recommended management for minimal or moderate lower urinary tract symptoms without impaired quality of life? (only one answer expected)","item":"HBP","matiere":"uro","propositions":[{"idx":0,"correct":true,"proposition":"Absentee-Surveillance","justification":"Hygiene-dietary rules can be established: water restriction after 6pm, limitation of alcohol and coffee consumption, treatment of associated constipation, cessation of treatments promoting dysuria."},{"idx":1,"correct":false,"proposition":"alpha-blockers","justification":""},{"idx":2,"correct":false,"proposition":"5-alpha-reductase inhibitor ","justification":""},{"idx":3,"correct":false,"proposition":"phospho-di-esterase inhibitor 5 ","justification":""},{"idx":4,"correct":false,"proposition":"Surgical treatment","justification":""}],"type":"custom"}