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In the case of a febrile roseoliform exanthema in children, the main etiologies are (one or more correct answers):

A sudden exanthema

Epidemic megalerythema

A rubella

Infectious mononucleosis

A kawasaki syndrome

Regarding heart failure, what is (are) the true statement (s)?

Cardiac auscultation can reveal a burst of B2 in the aortic area in cases of pulmonary arterial hypertension.

Cardiac auscultation can reveal a murmur of mitral insufficiency linked to the dilation of the mitral annulus.

Jugular turgor is a peripheral sign of left heart failure

Peripheral edema is soft, blue and painful

Crackles or subcrepitants are often bilateral

What is (are) the true answer(s) regarding the management of diffuse bronchiectasis in adults (outside a context of cystic fibrosis) responsible for repeated infectious episodes?

Daily bronchial drainage

Systemic corticosteroid therapy

Pulmonary lobectomy

Systematic quarterly antibiotic therapy course

Anti-inflammatory treatment with fluoroquinolone

A 58-year-old female patient comes to the emergency room of your hospital for expectorating two glasses of red blood while coughing. she had never coughed up blood. she is on anti-aggregating aspirin for coronary artery disease. her clinical examination is normal; his blood pressure is 132/79 mmhg. heart rate is 80/min. Chest x-ray does not show any abnormality. Give the correct answer(s)

You hospitalize the patient

You put in place vascular filling

You prescribe an intravenous vasoconstrictor agent such as telipressin

You prescribe an injected chest CT scan with acquisition in the arterial phase after verification of the absence of contraindication

You reassure the patient and explain to her that it is normal to bleed while taking anti-aggregants

A 55-year-old patient with hyperlymphocytosis at 25 g/l without cytopenia is referred to you with a diagnosis of chronic lymphocytic leukemia on lymphocyte immunophenotyping. On clinical examination, the patient is in excellent general condition and there is polyadenopathy of 1.5 to 2 cm in diameter in all lymph node areas. what examination is necessary at this stage? (only one answer)

None

Un tep-scanner

An echocardiogram

A myelogram

A bone scan

A 25-year-old man consults you because of abdominal pain. the examination is normal apart from a palpable spleen at the end of inspiration. the blood count shows: leukocytes 14 g/l, pnn 8 g/l, myelocytes 1 g/l, metamyelocytes 1g/l, monocytes 1 g/l, lymphocytes 3 g/l, platelets 510 g/l. you suspect chronic myelogenous leukemia. What biological tests do you prescribe to confirm your diagnostic hypothesis? (one or more possible answers)

Leukocyte immunophenotyping on blood

Search for jolly bodies by smear

Searching for the bcr-abl transcript

Gumprecht's Shadow Search

Search for a jak2 mutation

Which of the following statements regarding weakening osteopathies is (are) correct?

Primary hyperparathyroidism preferentially affects cortical bone

Treatment of hypothyroidism increases the risk of osteoporotic fracture

Cortisone osteoporosis mainly affects the cortical bone

Estrogen deficiency is responsible for osteoclast hyperactivity

Bisphosphonate treatment increases osteoblast activity

A 50-year-old woman arrives at the emergency room feeling unwell. she has no particular history but describes fatigue that quickly appeared. the clinical examination is normal apart from a conjunctival subcutaneous tissue. the blood count shows hemoglobin 90 g/l, red blood cells 2.7 t/l, hematocrit 27%, vgm 102 fl, ccmh 33 g/dl, leukocytes 8 g/l, polynuclear neutrophils 5 g/l, lymphocytes 2.3 g/l , monocytes 0.7 g/l. Which biological tests do you think are relevant to prescribe as first intention? (one or more possible answers)

C-reactive protein (crp)

Serum iron

Serum protein electrophoresis

Reticulocytes

Ldh

Which of the following infectious agents is(are) responsible for blood culture negative endocarditis?

Mycobacterium tuberculosis

Bartonella

Streptococcus pyogenes

Coxiella burnetii

Tropheryma whipplei

Which of the following infectious diseases is(are) required to be declared in France?

Rubella

Fish

Tuberculosis

Legionnaires' disease

Pneumococcie invasive

In a patient treated for 2 days for a proximal pulmonary embolism with unfractionated heparin, the tca ratio is 6 and the anti-xa activity is measured at peak activity at 1.2 iu/ml, in the absence of bleeding, whatever (s) measure(s) do you adopt immediately? (one or more possible answers)

Vitamin K intake

Infusion of concentrated platelet pellet

Perfusion de protamine

Discontinuation then dose adjustment

Introduction of avk

A 62-year-old man with no medical history presents with a spontaneous deep hematoma of the psoas muscle. the nfs shows hemoglobin at 90 g/l and platelets at 170 g/l. its hemostasis assessment is as follows: tca ratio at 2.1, tp at 78% and fibrinogen at 3.1g/l. mixing the patient's plasma with normal plasma does not allow the TCA to be corrected (Rosner index at 28 for normal < 15). the dosage of endogenous pathway factors reveals a factor viii at 4%. what diagnostic hypothesis(s) do you retain? (one or more possible answers)

The presence of a lupus-type anticoagulant

Constitutional hemophilia

The presence of an anti-factor VIII antibody

Willebrand disease type 1

Acquired hemophilia b

A patient is brought unconscious by the firefighters to the emergency room following a road accident. She presents with multiple trauma for which an emergency brain and thoraco-abdomino-pelvic scan are carried out. She presents with a fractured spleen which requires a surgical intervention. When she arrives, her husband tells you that she is approximately 8 weeks pregnant with amenorrhea. the irradiation dose received is 10 mgy. what are the risk(s) linked to the accident and treatment?

Developmental delay

Brain malformation

Abortion

Stunted growth

Retroplacental hematoma

A patient comes to your office for a preconception consultation. she is 32 years old, non-ligest. She has been followed for a year for well-controlled high blood pressure on perindopril, one tablet per day. She benefits from estrogen-progestin contraception which she plans to stop at the end of her pack. she weighs 81 kg for a height of 1m68. She consumes 5 cigarettes a day but would like to stop. What do you expect at the end of the consultation? (one or more correct answers)

Rubella serology

Help with smoking cessation using nicotine substitutes

Cervico-uterine smear if it is more than a year old

Prescription of folate at a dose of 5 mg/day

Stopping treatment with perindopril and switching to another antihypertensive

A 28-year-old woman consults for palpation of a swelling in the upper outer quadrant of the right breast. she is worried because her mother and her maternal aunt had breast cancer at ages 55 and 60 respectively. On clinical examination, you feel a round and regular swelling of 15 mm, non-adherent on the deep and superficial planes. there is no inflammation or skin retraction nearby. no suspicious lymphadenopathy is palpated in the axillary and supraclavicular lymph node areas. What examination(s) should be requested as a first intention?

A breast ultrasound

A chest x-ray

A dosage of ca 15-3

A breast MRI

A mammogram

A 38-year-old woman consults 3 months after her third birth for a request for contraception. she had a cesarean section even though her first two deliveries had taken place vaginally. she has just stopped breastfeeding her child because she has to return to her professional activity. in her history, she reports a uterine perforation during the insertion of an intrauterine device 7 years ago, phlebitis under plaster 10 years ago and cervical laser treatment 4 years ago for cervical dysplasia linked to a human papillomavirus infection. she does not smoke but “vapes” from time to time. the last cervico-uterine smear, taken at the start of pregnancy, was normal. What contraceptive method(s) is(are) possible for this woman?

Levonorgestrel intrauterine device

Copper intrauterine device

Transdermal patch releasing norelgestromin and ethinyl estradiol

Tubal sterilization by laparoscopy

Etonogestrel-releasing subcutaneous device

Faced with a suspicion of a metallic intraocular foreign body, what emergency examination(s) do you suggest?

An orbital scanner

An MRI

An x-ray of the orbit

Fluorescein angiography

A measurement of intraocular pressure

What is(are) the correct proposal(s) regarding voluntary termination of pregnancy (IVG) in France?

A woman under guardianship can request an abortion

A woman can request complete anonymity for an abortion

Insertion of an IUD is contraindicated immediately following a surgical abortion

Prostaglandins cannot be used in hereditary porphyria

A psychosocial interview must systematically be carried out before carrying out the abortion

A chalazion:

Is an infection of a pilosebaceous follicle of the eyelids

Is a resorption granuloma of a meibomian gland of the eyelids

Treated with corticosteroid ointment

Treated with systemic antibiotics

May require surgical incision

What are the possible etiologies of a reduction in visual acuity associated with ocular redness (several correct answers)?

Acute glaucoma attack due to angle closure

Anterior uveitis

Occlusion of the central retinal artery

Neovascular glaucoma

Retinal vasculitis

In case of myopia (one or more correct answers):

The optical system formed by the eye is too convergent

Distance vision is better than near vision without correction

Light rays focus in front of the retina

A divergent lens can be used for correction

Risk of retinal detachment may be increased

You are caring for an 83-year-old patient, well supported, on day two of a knee arthroplasty. the redon drains were removed without problem. She presents with an enlarged knee, very edematous and inflammatory. the scar is beautiful, non-inflammatory. what is(are) the correct proposition(s)?

Outpatient treatment is possible

The electrotherapy techniques practiced by the physiotherapist will aim to reduce edema

The English cane prescription could be made by the private physiotherapist after discharge from the hospital

Your physiotherapy prescription must mention the physiotherapy techniques to be used.

The adaptation of the home must be done after writing a file with the mdph (departmental center for disabled people)

You are caring for a 32-year-old patient, a computer scientist, whose smoking is estimated at 15 packs/year, with no medical or surgical history, victim of a road accident responsible for a severe spinal cord injury by c5 cervical fracture osteosynthesised by an anterior route on April 30, 2018. weaning from mechanical ventilation having been difficult, he was tracheotomized on May 21, 2018 after orotracheal intubation. weaning was then carried out on May 29. When he arrived, he was eupneic. he presents with a pressure sore of the right trochanter, stage 4 with loss of substance down to the bone. the bottom of the pressure sore is fibrinous and the purulent secretions are very abundant without any inflammatory skin signs. what is (are) the correct proposition(s)?

Tracheal stenosis is a complication of prolonged orotracheal intubation

For the treatment of this bedsore, you prefer a combination of local antiseptics and dry dressings.

The presence of this pressure sore indicates that the patient should be placed in a chair.

The lesion being at spinal level c6 you expect anesthesia from the lateral edge of the forearm in anatomical position

The request for long-term illness can be made by the attending physician

You prescribe a standard articulated knee orthosis to one of your patients with a knee sprain. check the correct prescription principle(s) for this type of medical device:

It is prescribed on a simple prescription

It is prescribed on a large equipment form

It is refunded 100% of its purchase price

It can be prescribed by all specialists

It can be prescribed by a physiotherapist

Regarding carpal tunnel syndrome, what is(are) the true statement(s)?

It is most often idiopathic

It is more common during pregnancy

Electromyogram is essential for diagnosis

It may lead to a deficit of the flexor pollicis longus

It may lead to an abolition of the stylo-radial reflex

Concerning knee osteoarthritis, what is(are) the true answer(s)?

Joint puncture is essential for diagnosis

A genu varum predisposes to medial femorotibial knee osteoarthritis

Viscosupplementation infiltrations are indicated in flare-ups with effusion

The surgical indication depends on the extent of joint narrowing

The effectiveness of corticosteroid infiltrations is limited in time

A 78-year-old former mechanic came to consult for severe inflammatory febrile back pain that had appeared 10 days ago. you suspect spondylodiscitis and you decide to prescribe a lumbar MRI. This patient has a total hip prosthesis installed 8 years ago and a valve prosthesis 2 years ago. he benefited from the placement of a coronary stent 3 months ago. it has a glomerular filtration rate of 48 ml/min. during interrogation, he tells you that he received metal shards in his right eye and right cheek 40 years ago. Which proposition(s) contraindicate(s) injected MRI?

Metal shards in the eye

The hip prosthesis

The valve prosthesis

The coronary stent

Kidney function

In case of paralysis of the oculomotor nerve (iii), you may encounter on examination?

A lack of elevation of the eye

a myosis

An eye adduction defect

An exophthalmos

Un ptosis

A 62-year-old patient has a history of essential hypertension treated with monotherapy for 2 years and active smoking (45 pack-years). for about two weeks, he has been complaining of daily headaches which usually appear during the second half of the night. At the beginning, they gradually faded during the morning. For about 3 days, they have been constant. These headaches are described as diffuse in the head, are fluctuating in intensity, and are accentuated by physical activity. he also complains of inappetence and nausea which are also progressive. the patient is afebrile. What syndrome do you evoke in front of this table?

Migraine status

Chronic daily headaches

Meningeal syndrome of infectious origin

Intracranial hypertension

Meningeal syndrome linked to subarachnoid hemorrhage

A 59-year-old patient saw a tremor appear in the last three fingers of his right hand, which those around him also noticed when walking. he swings his right upper limb less when walking. On examination, you notice that the tremor disappears with outstretched arms. you perceive that passive mobilization of the right elbow is more difficult and that mobilization of the right shoulder is painful. osteotendinous reflexes are normal. This type of tremor is probably aggravated by:

The emotion

I mentally calculate them

Writing

The movement

Sleep

Which of the following applies to a central neurological bladder?

The

Detrusor hypoactivity

Incontinence

Risk of ureterovesical reflux

Low intravesical pressures

Which of the following foods contain more than 5% carbohydrates?

Lenses

Green beans

Meat

Cheese

Fruits

Which of the following biological signs points you towards iatrogenic adrenal insufficiency in a 38-year-old patient with a history of Crohn's disease treated for 5 years with 10 mg/day of prednisone?

Sodium at 128 mmol/l

Potassium at 5.8 mmol/l

Fasting blood sugar at 3 mmol/l

Plasma acth at 8 hours at 585 pg/ml (n: 10 – 20)

Urinary free cortisol at 25 µg/24 hours (n: < 90)

You see in consultation a 15-day-old newborn who presents with an isolated fever of 38.2°C and a general condition that has not changed

You reassure parents about the benign nature of this fever during periods of viral epidemics

The flu test is not informative at this age

The urine dipstick is not informative at this age

Carrying out a cytobacteriological examination of urine is systematic

Performing a lumbar puncture is systematic

Faced with a lesion of the tongue, what is(are) the clinical sign(s) which will point towards a malignant origin?

Indurated lesion

Painful lesion

Bleeding on contact when palpating the lesion

Submucosal induration

Presence of associated leukoplakia

You intervene at the home of an infant found deceased by his parents a few minutes ago:

You ask to be accompanied by the police

You should not sign the death certificate before admission to the hospital

You write a report to the public prosecutor

You suggest that the parents carry out an autopsy to find the causes of death

The transfer of the body must be done to a forensic institute

You explain to young parents whose child has a first febrile episode the measure(s) to take during this episode.

Medicinal treatment is required for any temperature above 39°C

Drinking water is necessary every hour as long as the fever persists.

Cool wraps should be used if the child is uncomfortable

The use of ibuprofen is only possible after 3 months

The child must be kept out of communities for the duration of the fever.

Concerning cervical swelling, what is(are) the correct item(s)?

A thyroglossal tract cyst is mobile when swallowing

Right supraclavicular lymphadenopathy may indicate genitourinary cancer

A renitent superficial swelling located at the anterior edge of the sternocleidomastoid muscle is suggestive of an amygdaloid cyst

A brachial plexus schwannoma is a differential diagnosis of submandibular lymphadenopathy

An accessory nerve schwannoma is a differential diagnosis of spinal lymphadenopathy

Regarding peritonsillar phlegmon, what are the correct item(s)?

The abscess is located in the lateropharyngeal space

There may be trismus

The anterior pillar of the soft palate is widened

In adults, hospitalization is systematic

Drainage of the abscess is done either by puncture or incision under general anesthesia

Regarding benign paroxysmal positional vertigo, what is the correct item(s)?

It lasts less than a minute

It is caused by vestibular ischemia

It is treated with vestibular physiotherapy.

It is associated with tinnitus

There is a positional triggering factor

A 32-year-old patient consults the emergency room for asthenia. there are no other abnormalities on clinical examination. Biological examinations show an increase in transaminases with asat=1362 iu (n<40), alat=2348 iu (n<40). what is(are) the possible cause(s) of this increase in transaminases?

Acute viral hepatitis

Acute alcoholic hepatitis

Drug-induced hepatitis

Autoimmune hepatitis

Hepatitis linked to cannabis use

A 62-year-old patient presents with progressive onset hyponatremia. he appears euvolemic clinically. his biological blood test is as follows: na 125 mmol/l, k 4 mmol/l, chlorine 110 mmol/l, hco3- 25 mmol/l, blood sugar 5 mmol/l, proteins 67 g/l, urea 4 mmol/l, serum creatinine 78 µmol/l. Urine assessment: na 100 mmol/l, k 25 mmol/l, urea 350 mmol/l, creatinine 8 mmol/l. what is (are) the (are) possible cause(s) of this biological picture? (one or more correct answers)?

Tea and toast syndrome

Taking furosemide

Syndrome of inappropriate adh secretion

Taking amlodipine

Lithium intake

An 86-year-old patient is hospitalized for hematemesis. he is known to have viral hepatitis b, which has not been monitored. His family describes bloody vomit equivalent in volume to that of a basin. On examination, he presents ascites and asterixis. systolic blood pressure is 55 mmhg. Which of the following is(are) associated with a poor prognosis?

Age

Hematemesis volume

Blood pressure

Presence of hepatic encephalopathy

Presence of ascites

A 62-year-old patient presents the following biological assessment: na 142 mmol/l, k 5.7 mmol/l, chlorine 110 mmol/l, hco3- 18mmol/l, proteins 88 g/l, urea 20 mmol/l, serum creatinine 170 µmol/l. what drug(s) can give this biological picture? (one or more correct answers)

Ibuprofen

Candesartan

Amiloride

Amlodipine

Prednisone

You take care of a 67-year-old female patient in the emergency room whose reason for admission is pain in the right calf. The questioning and clinical examination reveal a progressive cancer during treatment and localized sensitivity along the deep venous network. RIGHT. the rest of the examination is unremarkable. you use a simplified clinical prediction model for deep vein thrombosis (dVT) which indicates a probability of dvt of 17%. you request a venous duplex of the lower limbs to confirm this suspicion of dvt. among Which of the following statements is (are) correct?

The post-test probability of DVT depends on the sensitivity of the venous Doppler ultrasound.

The pre-test probability of pVT depends on the specificity of the venous duplex scan.

The post-test probability of pVT depends on the likelihood ratio of venous duplex ultrasound.

The post-test probability of DVT depends on the intrinsic performance of venous Doppler ultrasound.

The post-test probability of TVP can be determined graphically using the Fagan nomogram.

A 43-year-old patient consulted for moderate hyperferritinemia twice the normal level discovered during a systematic assessment carried out by occupational medicine. he is asymptomatic. what element(s) will direct(s) towards metabolic hepatosiderosis?

High transferrin saturation coefficient

Overweight

Hypertriglyceridemia

Graves' disease

History of colon cancer

In the event of sigmoid diverticulitis, an injected abdominal-pelvic CT examination is performed. it can show (one or more correct answers):

Images of addition containing air at the anti-mesenteric edge of the colon

Thinning of the colonic wall

Fat infiltration around a diverticulum

Thickening of the colonic wall

Pylephlebitis

In what situation(s) does a patient benefit from an exemption from user fees (based on social security rates)?

Care of minor children of any nature

Care, whatever it may be, for subjects receiving state medical aid (ame)

Care, whatever it may be, for pregnant women from the 4th month of pregnancy

Performing a mammogram on a 54-year-old woman as part of the national breast cancer screening program

Additional examinations, outside of usual care, carried out as part of participation in a randomized trial

A 48-year-old patient has been experiencing headaches for several weeks leading to the diagnosis of high blood pressure. the average of his outpatient blood pressures is 177/92 mmhg. his biological assessment is as follows: na 142 mmol/l, k 3.4 mmol/l, serum creatinine 70 µmol/l, serum calcium 2.5 mmol/l. 24-hour diuresis: 1400 ml. urine ionogram: na=180 mmol/l, k=50 mmol/l, proteinuria <0.01g/l. In view of this assessment, what is (are) the cause (s) that you should mention for this high blood pressure?

Renal artery stenosis

Syndrome the Gitelman

Primary hyperaldosteronism

Chronic consumption of licorice

Phéochromocytome

Which tumor marker is of interest in the screening, diagnosis, prognosis and monitoring of the cancer of which it is specific? (1 answer)

Ace

Psa

Alpha fp

Hcg

Ca125

Within the framework of the law of February 2, 2016 known as the “Claeys-Leonetti” law, when a patient can no longer express himself, a treatment which appears useless, disproportionate or when it has no other effect than the sole artificial maintenance of life, may be suspended following a collegial procedure defined by regulation. what is (are) the element (s) provided for in this procedure?

Consultation of advance directives if they exist

The opinion of at least one consulting physician

A discussion with the members of the care team present

Information from the on-call director if this procedure takes place on the weekend

The decision must be entered in the medical file

What means(s) is used to assess the qualitative dimension of pain?

dn4 questionnaire

doloplus questionnaire

algoplus scale

Visual analog scale

Numerical scale

By what therapeutic means(s) can neuropathic pain be treated as first intention?

A tricyclic antidepressant

An antiepileptic drug from the gabapentinoid class

Morphine

Transcutaneous electrical stimulation

Spinal cord stimulation

A 55-year-old patient is treated in a palliative care unit for terminal development of respiratory failure complicating major emphysema. His main complaint is an increase in his dyspnea. how to manage this dyspnea? (one or more correct answer(s))

Symptom assessment using a visual analog scale

Adaptation of the flow rate of oxygen therapy so that arterial oxygen saturation is greater than 95%

Introduction or increase of opioid treatment

Comfortable patient installation

Deep and continuous sedation from the outset until death

Obesity surgery such as a longitudinal gastrectomy may be offered (one or more correct answers):

In adolescents from 15 years old if the BMI is greater than 40 kg/m2

In a 55-year-old subject, fitted for sleep apnea, with a BMI ≥ 35 kg/m2

In case of serious eating disorders

If the subject has understood and accepted lifelong post-operative medical and surgical follow-up

If the patient has received clear and complete information on the surgical risks

A 52-year-old patient with no particular history presents high blood pressure, proteinuria of 2 g/24 hours, hematuria of 105 red blood cells/ml with serum creatinine of 130 µmol/l. his vesico-renal ultrasound is normal. here is the report of his kidney biopsy: cortical fragment comprising 15 glomeruli including 4 sclerotic glomeruli. Permeable glomeruli exhibit mesangial and endocapillary proliferation. lesions of moderate arteriolosclerosis. lesions of tubular atrophy and interstitial fibrosis on approximately 20% of the parenchyma. immunofluorescence finds deposits of Iga to +++ in the mesangium and of c3 to 1+ in the vessels and glomeruli. what is(are) the possible diagnosis(es)?

Tubulointerstitial nephropathy

Lupus nephropathy class IV

Pauci-immune glomerulonephritis

Iga nephropathy

Nephroangiosclerosis

What elements point 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)?

Symptoms that improve during the holidays

A location of the lesions on the back of the hands and wrists

The presence of several simultaneous cases in the same workshop

A history of atopy in childhood

The presence of lesions on the eyelids

As a young general practitioner, you receive for the first time a 52-year-old patient who complains of insomnia, anxious ruminations, loss of vitality and disinvestment in family and professional life. he indicates that his symptoms appeared 6 months ago, following the arrival of a new team leader who constantly made remarks to him about his slowness at work and his lack of intellectual abilities. he even reports insults uttered against him on several occasions, when he was alone with his boss. This patient has no notable medical history, apart from depression reactive to a divorce 10 years ago. patient asks you to make a declaration of occupational illness. What should you indicate on the initial medical certificate?

The existence of a depressive syndrome

The date you first noticed the pathology

History of depressive syndrome

The existence of harassment by a colleague

The name of the department head

A 12-year-old patient is admitted to the pediatric emergency room for meningeal syndrome. he is placed in an examination room by a caregiver and the nurse comes to take his temperature and blood pressure. the intern then comes to examine the child and suspects an invasive meningococcal infection, which will be confirmed by analysis of the CSF (meningococcus c). the nurse, aged 30, comes to see the intern telling him that she is worried because she is pregnant and she asks her the question of what she should do because she took care of the child without a mask, and is not vaccinated against meningococcus. what measure(s) should be taken by her proposed?

Vaccination with the meningococcal c conjugate vaccine

Prophylaxis with oral rifampicin for 5 days

Prophylaxis with rifampicin orally for 2 days

Reassure her and tell her that there is no risk of contamination

Prophylaxis with ceftriaxone injection

What hygiene measures should be taken when entering the room for the treatment of a patient with pulmonary tuberculosis?

Wearing a long-sleeved jacket

Wearing a respiratory protection mask (type ffp2)

Wearing a charlotte

Wearing overshoes

Hand friction with a hydroalcoholic solution

What vaccinations are compulsory for a nurse working in a hospital in a healthcare department (one or more answers possible)?

Pneumococcus vaccination

Vaccination against diphtheria, tetanus and poliomyelitis

Hepatitis A vaccination

Whooping cough vaccination

Hepatitis B vaccination

Concerning acute peritonitis, what proposal(s) do you retain?

Abdominal CT is the reference morphological examination for diagnosis

Surgical treatment must include washing of the peritoneal cavity

The 3 most common causes are appendicitis, peptic ulcer, colonic diverticulum

The progressive risk of peritonitis is septic shock

Peritonitis is always linked to digestive perforation

Regarding acute intestinal obstruction, what is (are) the correct information?

A functional occlusion may be caused by a hydroelectrolyte disorder

A peritoneal flange can lead to occlusion by strangulation

Strangulation obstruction threatens the vitality of the intestine within hours

Abdominal CT with contrast product injection is the gold standard examination.

Colon cancer is the leading cause of colonic obstruction due to obstruction

Regarding occlusive syndrome: (one or more correct answers)

The cessation of materials is a physical sign absent in 30% of cases

Abdominal pain is always the initial symptom

The location of abdominal pain indicates the location of the obstacle

Repeated and frequent vomiting temporarily relieves abdominal pain in small bowel obstructions

The cessation of gas is the essential functional sign for diagnosis

Mr. m, aged 58, is referred to you for abnormalities in his iron assessment. In his history, we only note diabetes diagnosed 3 months ago. On clinical examination, the temperature is 37.3°C. you note hepatomegaly estimated at 5 cm under the costaldroit awning. his iron assessment is presented below: transferrin saturation coefficient (cst) at 62%, ferritin at 1200 ng/ml (normal 30 to 300 mg/ ml).among the following propositions, which (or which) of the following causes could explain the iron balance abnormalities presented in this clinical context?

Inflammatory syndrome

Dysmetabolic hepatosiderosis

Genetic hemochromatosis

Myelodysplasia

Syndrome d’activation macrophagique

When admitting a polytrauma patient in severe hemorrhagic shock (one or more correct answers):

A bodyscan is essential and must be carried out urgently

A fast echo performed at the patient's bedside is sufficient to confirm hemoperitoneum

Emergency laparotomy is indicated to confirm the abdominal origin of hemorrhagic shock.

In cases of massive hemoperitoneum, the “damage control” technique is the reference technique.

The “damage control” technique aims to control bleeding and at the same time treat digestive lesions

M. m., aged 22, consults urgently due to asthenia associated with a fever of 39°C that has been going on for 72 hours. he complains of odynophagia and diffuse myalgia. On clinical examination, you find cervical lymphadenopathy and splenomegaly across a finger. A blood test was carried out in town and shows the following results: hemoglobin 13.2 g/dl, vgm 89 fl, platelets 120 g/l, leukocytes 10.6 g/l, neutrophils 1.6 g/l, basophils 0.1 g/l, eosinophils 0.4 g/l, lymphocytes 8 g /l, monocytes 0.5 g/l. blood smear: presence of numerous large lymphocytes with hyper-basophilic cytoplasm. Among the following additional examinations, which one (or which ones) do you think should be carried out as first intention in this clinical context?

Myelogram

Lymphocyte immunophenotyping

p24 antigenemia

Mni test

Cytomegalovirus (cmv) serology

A patient presents with claudication for a distance estimated at 400 meters and which results in pain in the right calf. On clinical examination you note: the absence of edema of the lower limbs the presence of all peripheral pulses at the level in the left lower limb the popliteal pulse is however ample and very easy to palpate while on the right only the femoral pulse is felt there is neither sensory disturbance nor motor disturbance in the lower limbs. you finally find a left iliac murmur, what arterial lesion(s) should you suspect?

Left iliac obliteration

Left iliac stenosis

Left popliteal aneurysm

Right iliac obliteration

Right femoral obliteration

Regarding the murmur in mitral regurgitation, what is (are) the correct proposition(s)?

It is ejection mesosystolic

It is most often in a steam jet

It may be associated with a mesodiastolic turnover

It is most often of apexo-axillary location.

It radiates to the carotids

In a clinical trial, the random allocation (randomization) of the treatment evaluated is intended to:

Form comparable groups based on potential confounding factors

Conclude a difference with a statistical significance threshold of 5%

Mitigating Sampling Fluctuations

Keep subjects unaware of the treatment allocated for the entire study period

Reduce the number of topics needed

Measures of association that can be estimated in a cross-sectional etiological epidemiological study include:

The incidence rate

L'odds ratio

The mortality rate

The prevalence

The etiological fraction

In the following list of bacterial infections, which one(s) is(are) not usually associated with leukocytosis?

Gram-negative liver abscess

Acute pyelonephritis

Typhoid fever

Pneumococcal lung infection

Tuberculosis

Among the following parasitoses, which one(s) are transmitted by skin contact (walking barefoot, swimming) with water or damp soil?

Amoebae

Teniosis

Hydatidose (échinococcose)

Strongyloidose (anguillulose)

Schistosomiasis (bilharziasis)

the medical certificate describing injuries secondary to violence: (one or more correct answers)

Must mention the psychological impact of the violence on the victim

Can be handed over directly to a judicial police officer if the total incapacity for work is more than eight days

Can be given directly to a third party provided that they provide proof of their link with the victim

Is given to the holder of parental authority if the victim is a minor

Allows medically to establish the credibility of the victim's words

In the absence of a statistically significant difference in the primary endpoint between the two groups of a prospective randomized controlled trial against placebo, it is necessary to mention:

The risk of statistical error of the second kind (beta)

The lack of effect of the treatment

A lack of statistical power

The non-inferiority of the treatment evaluated

The risk of statistical error of the first type (alpha)

The association at autopsy of a recent, bilateral and multi-focal subdural hematoma and bilateral retinal hemorrhages in a 6-month-old baby with no particular history suggests the diagnosis of: (one or more correct answers)

Sudden infant death

Shaken baby syndrome

Syndrome de silverman

Rupture of cerebral arteriovenous malformation

Accidental head trauma

The administrative part of the death certificate, electronically or on paper, is transmitted: (one or more correct answers)

At the town hall of the place of death

At the National Institute of Health and Medical Research (INSERM)

To the manager of the funeral home mandated by the family

To the public prosecutor

To the family of the deceased

Congenital long QT syndrome is a hereditary rhythm disorder of autosomal dominant transmission which predisposes to sudden death in childhood and which can be the subject of preventive treatment. this pathology is very heterogeneous on the genetic level. what is(are) the correct proposition(s):

The genes involved encode ion channels

Long QT syndrome is most often associated with a congenital heart defect

The genetic evaluation of this pathology is done by the study of the karyotype

The diagnosis in an index case must lead to information for relatives

Molecular predictive diagnosis is not authorized in minor children in this situation

The drafting of a descriptive medical certificate requires the evaluation of the itt in the criminal sense of the term. what is the meaning of this acronym?

Total incapacity for work

Temporary total incapacity

Temporary total incapacity

The inability to work completely

Temporary total incapacity

You are seeing a pregnant woman for a morphological ultrasound at 22 weeks of amenorrhea. his couple has no family history. fetal growth is normal. she benefited from a combined screening in the first trimester with a risk of Down syndrome calculated at 1/10,000. the only particularity is fetal intestinal hyperechogenicity. what is(are) the correct proposition(s):

This is a warning sign of cystic fibrosis.

This is a warning sign of a viral infection.

This sign is frequently encountered in fetuses heterozygous for a severe mutation in the cftr gene.

We propose as a priority a search for heterozygosity in both parents

Priority is given to amniocentesis to look for mutations in the cftr gene in the fetus.

The objectives of the medico-legal treatment of a victim of sexual violence are: (one or more correct answers)

Describe traumatic bodily injuries

Determine whether the person consented at the time of the incident

Determining whether the victim's statements are credible

Establish multidisciplinary care

Take samples for genetic fingerprinting

What are the possible therapeutic strategies in asthma and chronic obstructive pulmonary disease (COPD)? (one or more correct answers)

Long-term inhaled corticosteroid therapy as monotherapy in COPD

Continuous inhaled corticosteroid therapy as monotherapy in asthma

Long-acting beta-2 agonist as monotherapy in asthma

Combination of inhaled corticosteroid and inhaled long-acting beta-2 agonist as background treatment in asthma

Long-acting beta-2 agonist as monotherapy in COPD

Name the potential consequence(s) of a drug combination with a cytochrome p450 3a4 inducing drug.

Graft rejection under cyclosporin

Pregnancy on estrogen-progestins

Ergotism in the presence of ergotamine

Rhabdomyolysis in the presence of certain statins

Antiretroviral treatment failure

You receive the result of a blood ionogram showing a serum potassium level of 6 mmol/l. what iatrogenic cause(s) can you mention?

Long-term oral corticosteroid therapy

Antagonist of angiotensin ii

Mineralocorticoid receptor inhibitor

ACE inhibitor

Loop diuretic

About drug antidotes:

Protamine sulfate neutralizes the anticoagulant activity of heparin

Naloxone is a specific antagonist of morphinomimetics

Prothrombin factors are the antidote for clopidogrel

N-acetyl-cysteine ​​is the antidote to acetylsalicylic acid

Flumazenil is an antagonist of benzodiazepines and related molecules

A 23-year-old young woman is hospitalized in a psychiatric ward for a state of psychomotor excitement that has been developing for a week, with disinhibition leading to reckless spending and risky sexual behavior. she has not slept for 72 hours but shows no fatigue and begins to introduce herself to each of the patients in the department. If you had to opt for monotherapy, which of these options would seem appropriate to you?

Lithium

Valproic acid

Risperidone

Carbamazepine

Quetiapine

About the decision to medically terminate a pregnancy (img) (one or more correct answers):

Any request for img must be the subject of an opinion from the multidisciplinary center for pre-natal diagnosis (cpdpn)

There is a list of pathologies for which there is a medical indication for img

The admissibility of the request is based on the demonstration of a “high probability of a particularly serious and incurable condition at the time of diagnosis”

A period of reflection must be offered to the pregnant woman between the diagnosis of the condition and the possible carrying out of the img

An img can be carried out after advice from the cpdpn until the end

A 31-year-old young woman describes the sudden onset, a month ago, of intense fatigue accompanied by deep sadness. she blames herself a lot, in particular for not being able to take care of her 2-month-old daughter, is very slow and often wakes up in the middle of the night. he then sometimes has suicidal thoughts. Which of the following characteristics may indicate bipolar mood disorder?

The female gender

Postpartum context

Sudden start

Melancholic characteristics

Suicidal thoughts

Among the following signs and symptoms, which one(s) is(are) more common in the event of a depressive episode in elderly people compared to young adults?

Somatic complaints

Feeling of guilt

Self-depreciation

Suicidal thoughts

Sexual disorders

Which of the following signs could be a symptom(s) of opiate withdrawal?

Constipation

Bilateral mydriasis

Hallucinations

Vomiting

High blood pressure

Faced with a patient presenting a disorder linked to alcohol use and opposed to the idea of ​​addiction treatment, what attitude(s) characterize(s) the motivational interview?

Give the patient arguments in favor of change

Let the patient explain what alcohol does for him

Expose the patient to situations at risk of excessive consumption

Identify the patient's personal reasons for change

Emphasize to the patient the risks associated with alcohol consumption

A 69-year-old patient presents for an annual visit to his new general practitioner. clinical examination reveals a pulse at 45 beats per minute. Name the medication(s) likely to be involved:

Selective beta blocker

Class III antiarrhythmic

Calcium channel blocker of the dihydropyridine group

Anticholinesterase

Fast-acting, short-acting inhaled beta-2 mimetic bronchodilator

About Down syndrome (one or more correct answers):

It most often results from a maternal meiotic accident

When it is associated with a chromosomal formula 46,xx,der(14;21),+21, it does not require a family investigation

Its postnatal diagnosis can be confirmed quickly by molecular biology

Its risk of recurrence is close to 1/100 to 1/200 for a couple who have had a first affected child.

Its risk is reduced by advanced maternal age at the time of conception

Regarding the histological lesions of glomerulopathies (one or more correct answers):

Diagnosis of minimal glomerular lesions requires electron microscopy examination.

Segmental and focal hyalinosis can be primary in adults

Membranoproliferative glomerulopathy is characterized by double contours of the glomerular basement membrane

Humps-like deposits are present in acute post-infectious glomerulonephritis

Diabetes can cause glomerulopathy

Histological diagnosis of prostate adenocarcinoma on biopsy mapping (one or more correct answers):

Typically requires six biopsy samples

May indicate extra-prostatic involvement

Requires a biopsy of the seminal vesicles

Is specified in its prognosis by the architectural score of gleason

Is specified in its prognosis by the proliferation index

During a surgical procedure, an extemporaneous examination of a tissue sample is requested. the sample must be sent to the anatomical pathology laboratory (one or more correct answers):

At + 4°c

At -20°c

Immersed in formalin

Without fixing liquid

Accompanied by a consent sheet

On a liver biopsy, we consider in favor of the diagnosis of acute alcoholic hepatitis (one or more correct answers):

Neutrophilic inflammation

Ballooned hepatocytes

Councilman bodies

Cirrhosis

Cholestasis

Molecular biology analyzes as part of the pathological diagnosis of a tumor (one or more correct answers):

Can be done on fixed and paraffin-embedded tissue samples

Can be done on unfixed tissue samples frozen at -80°C

Can be done on cell smears in liquid medium

Require morphological control of the tissue sample

Requires signed authorization from the patient

Regarding Alzheimer's disease, which statement(s) is(are) correct?

Diagnosis often remains late

This is secondary dementia

Behavioral disorders often appear at the start of the illness

The Dubois 5-word test makes it possible to make the diagnosis

It evolves in spurts leading to iterative hospitalizations

Concerning the aging of the organs, what is(are) the correct proposition(s):

It is marked by a reduction in maximum capacities

It is mainly due to oxidative stress

This is a concept without scientific proof

It is characterized by a reduction in functional reserve capacities

It allows us to judge the autonomy of the individual