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--- "a/english/dp_test.jsonl"
+++ "b/english/dp_test.jsonl"
@@ -1,115 +1,115 @@
-{"_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":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-7-qi-2","context":"You see a couple again in consultation due to primary infertility. They have been in a relationship for 8 years. Reports have been regular and unprotected for 18 months. There have been no pregnancies to date. Mrs. B. is 29 years old; She is Executive Secretary. She has a history of a mother with type 2 diabetes and a brother with type 1 diabetes. It weighs 60 kg for a height of 164 cm (BMI 22 kg\/m2). She does not take long-term treatment. It is G0P0. Its cycles are irregular, ranging from 35 to 65 days, without hot flashes. Mr. B., 32 years old, is a computer engineer. He has a history of allergic asthma and a bimalleolar fracture in adolescence following a skiing trauma. He is not currently taking any treatment. He practices triathlon in competition and trains an average of 10 hours per week (2 hours of indoor weight training, 3 hours of running, 1 hour of swimming and 4 hours of cycling on weekends). He does not smoke or consume alcohol very rarely. It weighs 64 kg for a height of 184 cm (BMI 18.9 kg\/m2). There is no notion of recent genital infection, nor of libido disorder. ","enonce":"Which of the following clinical situations could explain the results obtained on this spermogram ","item":"annales-2018-dp-7","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Sequelae of mumps orchitis","justification":""},{"idx":1,"correct":false,"proposition":"Bilateral agenesis of vas deferens","justification":""},{"idx":2,"correct":true,"proposition":"Y-chromosome microdeletion","justification":""},{"idx":3,"correct":true,"proposition":"History of cryptorchidism","justification":""},{"idx":4,"correct":false,"proposition":"Chronic prostatitis","justification":""}],"ts":{"$numberLong":"1665228551792"},"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":""}],"ts":{"$numberLong":"1665228551792"},"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":""}],"ts":{"$numberLong":"1665228551792"},"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":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-7-qi-6","context":"You see a couple again in consultation due to primary infertility. They have been in a relationship for 8 years. Reports have been regular and unprotected for 18 months. There have been no pregnancies to date. Mrs. B. is 29 years old; She is Executive Secretary. She has a history of a mother with type 2 diabetes and a brother with type 1 diabetes. It weighs 60 kg for a height of 164 cm (BMI 22 kg\/m2). She does not take long-term treatment. It is G0P0. Its cycles are irregular, ranging from 35 to 65 days, without hot flashes. Mr. B., 32 years old, is a computer engineer. He has a history of allergic asthma and a bimalleolar fracture in adolescence following a skiing trauma. He is not currently taking any treatment. He practices triathlon in competition and trains an average of 10 hours per week (2 hours of indoor weight training, 3 hours of running, 1 hour of swimming and 4 hours of cycling on weekends). He does not smoke or consume alcohol very rarely. It weighs 64 kg for a height of 184 cm (BMI 18.9 kg\/m2). There is no notion of recent genital infection, nor of libido disorder. ","enonce":"The molecular analysis of Mr. B.'s spermogram will confirm the microdeletion in the AZFc region of the Y chromosome. With regard to Mrs B., she has just made, at your request, a temperature curve. This one shows anovulatory cycles. Which of the following dosages will you prescribe as a first-line treatment for this patient?","item":"annales-2018-dp-7","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Anti-Müllerian hormone","justification":""},{"idx":1,"correct":true,"proposition":"Estradiol","justification":""},{"idx":2,"correct":true,"proposition":"Prolactin","justification":""},{"idx":3,"correct":true,"proposition":"FSH","justification":""},{"idx":4,"correct":false,"proposition":"SHBG","justification":""}],"ts":{"$numberLong":"1665228551792"},"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"}],"ts":{"$numberLong":"1665228551792"},"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":""}],"ts":{"$numberLong":"1665228551792"},"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":""}],"ts":{"$numberLong":"1665228551792"},"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":""}],"ts":{"$numberLong":"1665228551792"},"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":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-7-qi-12","context":"You see a couple again in consultation due to primary infertility. They have been in a relationship for 8 years. Reports have been regular and unprotected for 18 months. There have been no pregnancies to date. Mrs. B. is 29 years old; She is Executive Secretary. She has a history of a mother with type 2 diabetes and a brother with type 1 diabetes. It weighs 60 kg for a height of 164 cm (BMI 22 kg\/m2). She does not take long-term treatment. It is G0P0. Its cycles are irregular, ranging from 35 to 65 days, without hot flashes. Mr. B., 32 years old, is a computer engineer. He has a history of allergic asthma and a bimalleolar fracture in adolescence following a skiing trauma. He is not currently taking any treatment. He practices triathlon in competition and trains an average of 10 hours per week (2 hours of indoor weight training, 3 hours of running, 1 hour of swimming and 4 hours of cycling on weekends). He does not smoke or consume alcohol very rarely. It weighs 64 kg for a height of 184 cm (BMI 18.9 kg\/m2). There is no notion of recent genital infection, nor of libido disorder. ","enonce":"The TSH result is given by the laboratory: 52 mUl\/l (N: 0.4 - 4). Which of the following exams do you prescribe now?","item":"annales-2018-dp-7","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Anti-thyroglobulin antibodies","justification":""},{"idx":1,"correct":true,"proposition":"Anti-thyroperoxidase antibodies","justification":""},{"idx":2,"correct":false,"proposition":"Anti-TSH receptor antibodies","justification":""},{"idx":3,"correct":false,"proposition":"T3 free"},{"idx":4,"correct":false,"proposition":"Thyroid scintigraphy"}],"ts":{"$numberLong":"1665228551792"},"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":""}],"ts":{"$numberLong":"1665228551792"},"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":""}],"ts":{"$numberLong":"1665228551792"},"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)"}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-2-qi-2","context":"You see in consultation in September a 19-year-old patient for respiratory discomfort such as wheezing sensations and chest tightness. She has been smoking 10 cigarettes a day for 3 years. It has no other particular antecedent. She is a student at the School of Fine Arts and passionate about wood carving, an activity she only does during the week and which she will make her job. At the interrogation, there are no other particular symptoms. She has no fever and the clinical examination when you see her is strictly normal. She says she is very often woken up at night by these unpleasant or even distressing sensations. Her symptoms have appeared since she lives in her student apartment and left her childhood home. This is a small apartment in a rather dilapidated accommodation. She took her cat to this new home. She has this cat for 5 years while she was still living with these parents but contact with the cat had never been a problem for her until then. She has no other animals. She presents you with a chest x-ray taken 3 days ago.","enonce":"For this young patient, what additional tests do you offer?","item":"annales-2019-dp-2","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Bronchial fibroscopy","justification":""},{"idx":1,"correct":false,"proposition":"Arterial gasometry","justification":""},{"idx":2,"correct":true,"proposition":"Conducting prick-tests","justification":"Achievable from 3 years. A chest x-ray (which is normal in asthma) is also done."},{"idx":3,"correct":true,"proposition":"EFR","justification":"Achievable from 6 years old"},{"idx":4,"correct":false,"proposition":"esophageal pH","justification":""}],"ts":{"$numberLong":"1665228769750"},"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."}],"ts":{"$numberLong":"1665228769750"},"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":""}],"ts":{"$numberLong":"1665228769750"},"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."}],"ts":{"$numberLong":"1665228769750"},"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":""}],"ts":{"$numberLong":"1665228769750"},"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":""}],"ts":{"$numberLong":"1665228769750"},"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":""}],"ts":{"$numberLong":"1665228769750"},"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":""}],"ts":{"$numberLong":"1665228769750"},"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":""}],"ts":{"$numberLong":"1665228769750"},"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."}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-2-qi-12","context":"You see in consultation in September a 19-year-old patient for respiratory discomfort such as wheezing sensations and chest tightness. She has been smoking 10 cigarettes a day for 3 years. It has no other particular antecedent. She is a student at the School of Fine Arts and passionate about wood carving, an activity she only does during the week and which she will make her job. At the interrogation, there are no other particular symptoms. She has no fever and the clinical examination when you see her is strictly normal. She says she is very often woken up at night by these unpleasant or even distressing sensations. Her symptoms have appeared since she lives in her student apartment and left her childhood home. This is a small apartment in a rather dilapidated accommodation. She took her cat to this new home. She has this cat for 5 years while she was still living with these parents but contact with the cat had never been a problem for her until then. She has no other animals. She presents you with a chest x-ray taken 3 days ago.","enonce":"Regarding inhaled corticosteroids, what are the classic side effects? Give the correct answer(s).","item":"annales-2019-dp-2","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Cramps","justification":""},{"idx":1,"correct":true,"proposition":"Dysphonia","justification":""},{"idx":2,"correct":true,"proposition":"Oral pharyngeal mycosis","justification":""},{"idx":3,"correct":false,"proposition":"Tremors","justification":""},{"idx":4,"correct":false,"proposition":"Peptic ulcer","justification":""}],"ts":{"$numberLong":"1665228769750"},"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."}],"ts":{"$numberLong":"1665228769750"},"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":""}],"ts":{"$numberLong":"1665228769750"},"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.'"}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-4-qi-1","context":"A 76-year-old man consults for a bullous rash that appeared for a few days. He has been treated for heart failure for 13 years with beta-blocker (bisoprolol) and a combination of an angiotensin receptor type 2 antagonist and a diuretic (valsartan, hydrochlorothiazide). He also has type 2 diabetes treated with diet and metformin. He lives with his disabled wife. He complains of pruritus and dry skin for about 8 months. The clinical examination reveals bubbles in the trunk and upper limbs (Photo). Examination of the mucous membranes is normal. It presents an average of 30 new bubbles per day. He has been applying for several weeks a topical corticosteroid of moderate activity (desonide) associated with a dose of 25 mg of hydroxyzine (anti-histamine) at bedtime. ","enonce":"Which semiological element(s) do you identify in the photo? ","item":"annales-2019-dp-4","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Urticarian cupboards","justification":""},{"idx":1,"correct":true,"proposition":"Vesicles","justification":""},{"idx":2,"correct":true,"proposition":"Bubbles","justification":""},{"idx":3,"correct":false,"proposition":"Pustules","justification":""},{"idx":4,"correct":true,"proposition":"Erosions","justification":""}],"ts":{"$numberLong":"1665228769750"},"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":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-4-qi-3","context":"A 76-year-old man consults for a bullous rash that appeared for a few days. He has been treated for heart failure for 13 years with beta-blocker (bisoprolol) and a combination of an angiotensin receptor type 2 antagonist and a diuretic (valsartan, hydrochlorothiazide). He also has type 2 diabetes treated with diet and metformin. He lives with his disabled wife. He complains of pruritus and dry skin for about 8 months. The clinical examination reveals bubbles in the trunk and upper limbs (Photo). Examination of the mucous membranes is normal. It presents an average of 30 new bubbles per day. He has been applying for several weeks a topical corticosteroid of moderate activity (desonide) associated with a dose of 25 mg of hydroxyzine (anti-histamine) at bedtime. ","enonce":"You suspect a bullous pemphigoid. Which of the following characteristics(are) compatible with the diagnosis?","item":"annales-2019-dp-4","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Bubbles in healthy skin","justification":""},{"idx":1,"correct":true,"proposition":"Tense bubbles","justification":""},{"idx":2,"correct":false,"proposition":"Predominant mucosal involvement","justification":"This is found in pemphigus and hereditary epidermolysis bullosa (which is found in children), for example."},{"idx":3,"correct":true,"proposition":"A localization at the root of the members","justification":""},{"idx":4,"correct":true,"proposition":"Intense pruritus","justification":"This is a classic symptom"}],"ts":{"$numberLong":"1665228769750"},"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":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-4-qi-5","context":"A 76-year-old man consults for a bullous rash that appeared for a few days. He has been treated for heart failure for 13 years with beta-blocker (bisoprolol) and a combination of an angiotensin receptor type 2 antagonist and a diuretic (valsartan, hydrochlorothiazide). He also has type 2 diabetes treated with diet and metformin. He lives with his disabled wife. He complains of pruritus and dry skin for about 8 months. The clinical examination reveals bubbles in the trunk and upper limbs (Photo). Examination of the mucous membranes is normal. It presents an average of 30 new bubbles per day. He has been applying for several weeks a topical corticosteroid of moderate activity (desonide) associated with a dose of 25 mg of hydroxyzine (anti-histamine) at bedtime. ","enonce":"What paraclinical examination(s) do you perform to confirm the diagnosis of bullous pemphigoid? Give the correct answer(s).","item":"annales-2019-dp-4","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Tzanck cytodiagnosis","justification":""},{"idx":1,"correct":false,"proposition":"Electron microscopy","justification":""},{"idx":2,"correct":true,"proposition":"Biopsy for standard histology","justification":""},{"idx":3,"correct":true,"proposition":"Direct cutaneous immunofluorescence","justification":"Direct to the skin. Indirect for blood 🩸 ."},{"idx":4,"correct":false,"proposition":"Culturing the bubble liquid","justification":""}],"ts":{"$numberLong":"1665228769750"},"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":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-4-qi-7","context":"A 76-year-old man consults for a bullous rash that appeared for a few days. He has been treated for heart failure for 13 years with beta-blocker (bisoprolol) and a combination of an angiotensin receptor type 2 antagonist and a diuretic (valsartan, hydrochlorothiazide). He also has type 2 diabetes treated with diet and metformin. He lives with his disabled wife. He complains of pruritus and dry skin for about 8 months. The clinical examination reveals bubbles in the trunk and upper limbs (Photo). Examination of the mucous membranes is normal. It presents an average of 30 new bubbles per day. He has been applying for several weeks a topical corticosteroid of moderate activity (desonide) associated with a dose of 25 mg of hydroxyzine (anti-histamine) at bedtime. ","enonce":"Direct cutaneous immunofluorescence confirms the diagnosis of bullous pemphigoid. Indeed, it highlights (the) following element(s):","item":"annales-2019-dp-4","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Granular deposits of C3 on the dermal-epidermal junction","justification":""},{"idx":1,"correct":true,"proposition":"Linear IgG deposits on the dermal-epidermal junction","justification":""},{"idx":2,"correct":false,"proposition":"Linear deposits of IgA on the dermal-epidermal junction","justification":""},{"idx":3,"correct":false,"proposition":"Intercellular IgM deposits","justification":""},{"idx":4,"correct":true,"proposition":"Linear deposits of C3 on the dermal-epidermal junction","justification":""}],"ts":{"$numberLong":"1665228769750"},"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"}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-4-qi-9","context":"A 76-year-old man consults for a bullous rash that appeared for a few days. He has been treated for heart failure for 13 years with beta-blocker (bisoprolol) and a combination of an angiotensin receptor type 2 antagonist and a diuretic (valsartan, hydrochlorothiazide). He also has type 2 diabetes treated with diet and metformin. He lives with his disabled wife. He complains of pruritus and dry skin for about 8 months. The clinical examination reveals bubbles in the trunk and upper limbs (Photo). Examination of the mucous membranes is normal. It presents an average of 30 new bubbles per day. He has been applying for several weeks a topical corticosteroid of moderate activity (desonide) associated with a dose of 25 mg of hydroxyzine (anti-histamine) at bedtime. ","enonce":"Immediate management of this patient requires (one or more exact answer(s)):","item":"annales-2019-dp-4","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"An assessment of his hydration status","justification":""},{"idx":1,"correct":true,"proposition":"High-calorie nutrition","justification":""},{"idx":2,"correct":false,"proposition":"Hospitalization in intensive care","justification":"This would have been true in case of a sign of organic decompensation."},{"idx":3,"correct":false,"proposition":"Broad-spectrum antibiotic therapy","justification":"But we put local antiseptics (on the pierced bubbles)"},{"idx":4,"correct":false,"proposition":"Immediate cessation of treatment for heart failure","justification":"Why do this?"}],"ts":{"$numberLong":"1665228769750"},"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":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-4-qi-11","context":"A 76-year-old man consults for a bullous rash that appeared for a few days. He has been treated for heart failure for 13 years with beta-blocker (bisoprolol) and a combination of an angiotensin receptor type 2 antagonist and a diuretic (valsartan, hydrochlorothiazide). He also has type 2 diabetes treated with diet and metformin. He lives with his disabled wife. He complains of pruritus and dry skin for about 8 months. The clinical examination reveals bubbles in the trunk and upper limbs (Photo). Examination of the mucous membranes is normal. It presents an average of 30 new bubbles per day. He has been applying for several weeks a topical corticosteroid of moderate activity (desonide) associated with a dose of 25 mg of hydroxyzine (anti-histamine) at bedtime. ","enonce":"Additional therapeutic and monitoring measures are envisaged. Which of the following proposals do you retain? ","item":"annales-2019-dp-4","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Close monitoring of kidney function","justification":"The risk of dehydration pushes us to monitor kidney function in front of the risk of functional renal failure."},{"idx":1,"correct":false,"proposition":"Prescription of antihistamines","justification":"They are not useful. The best antipruritic is etiological treatment (corticosteroids, with their anti-inflammatory effect, will decrease pruritus)."},{"idx":2,"correct":true,"proposition":"Realization of antiseptic baths","justification":""},{"idx":3,"correct":true,"proposition":"Blood glucose monitoring","justification":""},{"idx":4,"correct":false,"proposition":"Substitution of oral antidiabetic drugs with insulin","justification":"Depending on renal monitoring."}],"ts":{"$numberLong":"1665228769750"},"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":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-4-qi-13","context":"A 76-year-old man consults for a bullous rash that appeared for a few days. He has been treated for heart failure for 13 years with beta-blocker (bisoprolol) and a combination of an angiotensin receptor type 2 antagonist and a diuretic (valsartan, hydrochlorothiazide). He also has type 2 diabetes treated with diet and metformin. He lives with his disabled wife. He complains of pruritus and dry skin for about 8 months. The clinical examination reveals bubbles in the trunk and upper limbs (Photo). Examination of the mucous membranes is normal. It presents an average of 30 new bubbles per day. He has been applying for several weeks a topical corticosteroid of moderate activity (desonide) associated with a dose of 25 mg of hydroxyzine (anti-histamine) at bedtime. ","enonce":"After 3 months of a well-conducted treatment with very strong local corticosteroids, the patient still presents bubbles, severe skin atrophy, many milia grains, extensive erosions in the thighs, heel bedsores, ecchymotic purpura of the arms. Which of the following is(s) induced by very strong prolonged corticosteroid therapy? ","item":"annales-2019-dp-4","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Milium grains","justification":""},{"idx":1,"correct":false,"proposition":"Bubble persistence","justification":""},{"idx":2,"correct":true,"proposition":"Ecchymotic purpura","justification":""},{"idx":3,"correct":false,"proposition":"Pressure ulcer heel","justification":"Topical corticosteroids are not a priori applied to the heel."},{"idx":4,"correct":true,"proposition":"Skin atrophy","justification":""}],"ts":{"$numberLong":"1665228769750"},"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":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-4-qi-15","context":"A 76-year-old man consults for a bullous rash that appeared for a few days. He has been treated for heart failure for 13 years with beta-blocker (bisoprolol) and a combination of an angiotensin receptor type 2 antagonist and a diuretic (valsartan, hydrochlorothiazide). He also has type 2 diabetes treated with diet and metformin. He lives with his disabled wife. He complains of pruritus and dry skin for about 8 months. The clinical examination reveals bubbles in the trunk and upper limbs (Photo). Examination of the mucous membranes is normal. It presents an average of 30 new bubbles per day. He has been applying for several weeks a topical corticosteroid of moderate activity (desonide) associated with a dose of 25 mg of hydroxyzine (anti-histamine) at bedtime. ","enonce":"Bacteriological sampling of bubble fluid identifies group B streptococcus. What treatment do you offer as a first-line treatment? ","item":"annales-2019-dp-4","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Fusidic acid cream","justification":""},{"idx":1,"correct":true,"proposition":"Amoxicillin","justification":"It is the treatment of choice for Streptococcus pyogenes."},{"idx":2,"correct":false,"proposition":"Doxycycline","justification":""},{"idx":3,"correct":false,"proposition":"Terbinafine","justification":""},{"idx":4,"correct":false,"proposition":"Trimethoprim-sulfamethoxazole","justification":""}],"ts":{"$numberLong":"1665228769750"},"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":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-10-qi-2","context":"Ms B, 35, consults her GP for unusual asthenia. In his medical history, we note: - substituted hypothyroidism; - a road accident in 1990 with multiple fractures and transfusions; - post-transfusion hepatitis C cured; - superficial venous thrombosis 2 years ago; Never deep thrombosis - no pregnancy The patient's usual treatment includes: levothyroxine 75 µg.","enonce":"Your patient reports that this unusual fatigue has been evolving in recent weeks. Weight is stable, sleep is preserved. The patient does not have mood sadness or other elements suggestive of a depressive syndrome. This fatigue increases during the day and with effort, and is associated with dyspnea also with effort. In general, what is the exact clinical element(s)? (one or more true propositions)","item":"annales-2019-dp-10","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Mucocutaneous pallor is specific for anemic syndrome","justification":"Sensitive but non-specific"},{"idx":1,"correct":false,"proposition":"An asthenia that increases during the day is specific to an organic cause","justification":"'Specific' and 'asthenia' are oxymorons 😉"},{"idx":2,"correct":true,"proposition":"Weight loss with preserved or even increased appetite can lead to endocrinopathy","justification":"Like diabetes for example"},{"idx":3,"correct":false,"proposition":"Melanonychia can lead to a martial deficiency","justification":""},{"idx":4,"correct":true,"proposition":"Melanoderma can lead to adrenal insufficiency","justification":""}],"ts":{"$numberLong":"1665228769750"},"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":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-10-qi-4","context":"Ms B, 35, consults her GP for unusual asthenia. In his medical history, we note: - substituted hypothyroidism; - a road accident in 1990 with multiple fractures and transfusions; - post-transfusion hepatitis C cured; - superficial venous thrombosis 2 years ago; Never deep thrombosis - no pregnancy The patient's usual treatment includes: levothyroxine 75 µg.","enonce":"The patient presents the results of a blood count performed the previous week at the request of her general practitioner: hemoglobin 7.5 g\/dL, MCV 102 fL, leukocytes 5.5 G\/L, complete blood count with polynuclear (PN) neutrophils 3.8 G\/L, eosinophilic PN 0.08 G\/L, basophilic PN 0.02 G\/L, lymphocytes 1.2 G\/L, monocytes 0.46 G\/L,  1, blisters 160 g\/l. \nAt this stage of the care, which of the following additional examinations seems to you (seem) lawful to prescribe as a first intention? (one or more exact propositions)","item":"annales-2019-dp-10","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Transthoracic cardiac ultrasound","justification":""},{"idx":1,"correct":false,"proposition":"Pulmonary function tests","justification":""},{"idx":2,"correct":false,"proposition":"Ferritinemia"},{"idx":3,"correct":true,"proposition":"Blood grouping and search for irregular agglutinins","justification":"We may have to transfuse it"},{"idx":4,"correct":true,"proposition":"Reticulocyte count"}],"ts":{"$numberLong":"1665228769750"},"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":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-10-qi-6","context":"Ms B, 35, consults her GP for unusual asthenia. In his medical history, we note: - substituted hypothyroidism; - a road accident in 1990 with multiple fractures and transfusions; - post-transfusion hepatitis C cured; - superficial venous thrombosis 2 years ago; Never deep thrombosis - no pregnancy The patient's usual treatment includes: levothyroxine 75 µg.","enonce":"The patient is hospitalized and additional blood tests are performed urgently, resulting in: hemoglobin 6.9 g\/dL, MCV 103 fi; reticulocytes 300 G\/L, leukocytes 6, 1 G\/L, complete blood count with polynuclear (PN) neutrophils 4.2 G\/L, Eosinophilic PN 0.08 G\/L, Basophilic PN: 0.02 G\/L, lymphocytes 1.3 G\/L, monocytes 0.46, platelets 150 G\/L, Na 145 mmol\/L; K 4.5 mmol\/L; Cl 105 mmol\/L; urea 3.5 mmol\/L; creatinine 74 μmol\/L; C-reactive protein 3.6 mg\/L; LDH 772 IU\/L; total bilirubin 40 μmol\/L; conjugated bilirubin 5 μmol\/L; AST 50 IU\/L (N: 8-35); ALT 45 IU\/L (N: 8-25); alkaline phosphatase 54 IU\/L; GGT 53 IU\/L; Haptoglobin < 0.1 g\/L. Apart from the erythrocyte Coombs test (direct antiglobulin test), which of the following tests seems most relevant to you to complete, at this stage, the assessment of your patient (only one expected response) ","item":"annales-2019-dp-10","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Serum vitamin B12 determination","justification":""},{"idx":1,"correct":false,"proposition":"TSH test","justification":""},{"idx":2,"correct":true,"proposition":"Blood smear","justification":""},{"idx":3,"correct":false,"proposition":"Blood lead level","justification":""},{"idx":4,"correct":false,"proposition":"Determination of ADAMTS13 activity","justification":""}],"ts":{"$numberLong":"1665228769750"},"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"}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-10-qi-8","context":"Ms B, 35, consults her GP for unusual asthenia. In his medical history, we note: - substituted hypothyroidism; - a road accident in 1990 with multiple fractures and transfusions; - post-transfusion hepatitis C cured; - superficial venous thrombosis 2 years ago; Never deep thrombosis - no pregnancy The patient's usual treatment includes: levothyroxine 75 µg.","enonce":"The blood smear performed on your patient does not find schizocytes or abnormal cells. It is noted the presence of a few spherocytes. You are faxed the first results of the erythrocyte Coombs test (direct antiglobulin test), which are presented below. \nIn view of the above results, which diagnosis do you think is most likely? (only 1 answer expected)","item":"annales-2019-dp-10","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Warm antibody autoimmune hemolytic anemia","justification":""},{"idx":1,"correct":false,"proposition":"Cold agglutinin disease","justification":""},{"idx":2,"correct":false,"proposition":"Paroxysmal haemoglobinuria 'a frigore'","justification":""},{"idx":3,"correct":false,"proposition":"Hereditary spherocytosis"},{"idx":4,"correct":false,"proposition":"Post-transfusion alloimmune hemolytic anemia","justification":""}],"ts":{"$numberLong":"1665228769750"},"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":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-10-qi-10","context":"Ms B, 35, consults her GP for unusual asthenia. In his medical history, we note: - substituted hypothyroidism; - a road accident in 1990 with multiple fractures and transfusions; - post-transfusion hepatitis C cured; - superficial venous thrombosis 2 years ago; Never deep thrombosis - no pregnancy The patient's usual treatment includes: levothyroxine 75 µg.","enonce":"Which of the following additional examinations will you perform on your patient?","item":"annales-2019-dp-10","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Serum protein electrophoresis","justification":""},{"idx":1,"correct":true,"proposition":"HIV serology","justification":""},{"idx":2,"correct":false,"proposition":"Anti-cytoplasmic antibodies of neutrophils","justification":""},{"idx":3,"correct":true,"proposition":"Anti-nuclear antibodies","justification":""},{"idx":4,"correct":false,"proposition":"Bone scintigraphy","justification":""}],"ts":{"$numberLong":"1665228769750"},"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"}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-10-qi-12","context":"Ms B, 35, consults her GP for unusual asthenia. In his medical history, we note: - substituted hypothyroidism; - a road accident in 1990 with multiple fractures and transfusions; - post-transfusion hepatitis C cured; - superficial venous thrombosis 2 years ago; Never deep thrombosis - no pregnancy The patient's usual treatment includes: levothyroxine 75 µg.","enonce":"You retain the diagnosis of systemic lupus with secondary Gougerot-Sjôgren's syndrome, and complicated autoimmune hemolytic anemia with warm antibodies. Which of the following treatments will you start as part of your patient's care? ","item":"annales-2019-dp-10","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Hydroxychloroquine","justification":""},{"idx":1,"correct":true,"proposition":"Systemic corticosteroid therapy","justification":""},{"idx":2,"correct":false,"proposition":"Curative anticoagulation","justification":""},{"idx":3,"correct":true,"proposition":"Pneumococcal vaccination","justification":"Due to long-term systemic corticosteroid therapy"},{"idx":4,"correct":false,"proposition":"Haemophilus influenzae vaccination","justification":""}],"ts":{"$numberLong":"1665228769750"},"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":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-10-qi-14","context":"Ms B, 35, consults her GP for unusual asthenia. In his medical history, we note: - substituted hypothyroidism; - a road accident in 1990 with multiple fractures and transfusions; - post-transfusion hepatitis C cured; - superficial venous thrombosis 2 years ago; Never deep thrombosis - no pregnancy The patient's usual treatment includes: levothyroxine 75 µg.","enonce":"While corticosteroid therapy has just been started, your patient reports retrosternal chest pain constrictive to exercise. The control of the blood count finds a hemoglobin assay at 4.8 g \/ dL. You decide to transfuse your patient urgently. Regarding the realization of this transfusion of red blood cells (CGR), which of the following proposals is (are) accurate?","item":"annales-2019-dp-10","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"CGR for clinical use are systematically subject to leukocyte removal","justification":""},{"idx":1,"correct":true,"proposition":"The transfusion of a CGR issued must begin within 6 hours of arrival in the clinical department","justification":""},{"idx":2,"correct":false,"proposition":"There is an indication to prescribe irradiated CGR in the case of your patient","justification":""},{"idx":3,"correct":true,"proposition":"It is recommended to use RH-KEL 1 phenocompatible CGRs in the case of your patient","justification":"Because it is likely that it is polytransfused"},{"idx":4,"correct":false,"proposition":"It is recommended to use deplasmatized RGCs in the case of your patient","justification":""}],"ts":{"$numberLong":"1665228769750"},"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":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-13-qi-1","context":"A 42-year-old patient comes to see you at your office for febrile pharyngeal pain. This lady's main history is a road accident in 2001 with ruptured spleen requiring partial splenectomy, unlabeled episodes of tachycardia, essential hypertension treated with hydrochlorothiazide and chronic alcoholism (8 cans of beer per day). She smokes a pack of cigarettes a day. She is a mother of 4 children but lives alone, custody of her children having been taken away from her. She is currently unemployed (former cleaner), occasionally has paid sex. She has had a fever and throat pain for 24 hours. The throat exam is as follows:","enonce":"What clinical data(s) should you particularly research in this context to refine the diagnosis and management of this ENT problem? ","item":"annales-2019-dp-13","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Odynophagy","justification":"It's the esophagus ^^ So it's not ENT"},{"idx":1,"correct":true,"proposition":"Fever intensity","justification":"Enters Mac Isaac's score"},{"idx":2,"correct":true,"proposition":"Conjunctivitis","justification":"Conjunctivitis possibly associated with an ENT problem, which changes its management"},{"idx":3,"correct":true,"proposition":"Cough","justification":"Enters Mac Isaac's score"},{"idx":4,"correct":true,"proposition":"Cervical lymphadenopathy","justification":"Enters Mac Isaac's score"}],"ts":{"$numberLong":"1665228769750"},"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":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-13-qi-3","context":"A 42-year-old patient comes to see you at your office for febrile pharyngeal pain. This lady's main history is a road accident in 2001 with ruptured spleen requiring partial splenectomy, unlabeled episodes of tachycardia, essential hypertension treated with hydrochlorothiazide and chronic alcoholism (8 cans of beer per day). She smokes a pack of cigarettes a day. She is a mother of 4 children but lives alone, custody of her children having been taken away from her. She is currently unemployed (former cleaner), occasionally has paid sex. She has had a fever and throat pain for 24 hours. The throat exam is as follows:","enonce":"It is indeed a boil. What could be the complications of this thigh boil? ","item":"annales-2019-dp-13","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Subcutaneous abscess","justification":""},{"idx":1,"correct":true,"proposition":"Acute dermohypodermatitis","justification":""},{"idx":2,"correct":false,"proposition":"Femoral iliac thrombophlebitis","justification":""},{"idx":3,"correct":true,"proposition":"Lymphangitis","justification":"The boil can be complicated by lymphangitis, furunculosis, antrax, dermohypodermitis, rare and severe malignant staphyllococcal disease of the face."},{"idx":4,"correct":false,"proposition":"Malignant staphylococcal disease","justification":"Only at the level of the face"}],"ts":{"$numberLong":"1665228769750"},"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":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-13-qi-5","context":"A 42-year-old patient comes to see you at your office for febrile pharyngeal pain. This lady's main history is a road accident in 2001 with ruptured spleen requiring partial splenectomy, unlabeled episodes of tachycardia, essential hypertension treated with hydrochlorothiazide and chronic alcoholism (8 cans of beer per day). She smokes a pack of cigarettes a day. She is a mother of 4 children but lives alone, custody of her children having been taken away from her. She is currently unemployed (former cleaner), occasionally has paid sex. She has had a fever and throat pain for 24 hours. The throat exam is as follows:","enonce":"The rapid diagnostic test for group A streptococcus is positive. What antibiotic treatment do you initiate as a first-line treatment:","item":"annales-2019-dp-13","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Amoxicillin","justification":"We aim for streptococcus, it is the best antibiotic"},{"idx":1,"correct":false,"proposition":"Amoxiclin and clavulanic acid","justification":""},{"idx":2,"correct":false,"proposition":"Pristinamycin","justification":""},{"idx":3,"correct":false,"proposition":"Cefuroxime","justification":""},{"idx":4,"correct":false,"proposition":"Ceftriaxone","justification":""}],"ts":{"$numberLong":"1665228769750"},"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"}],"ts":{"$numberLong":"1665228769750"},"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"}],"ts":{"$numberLong":"1665228769750"},"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":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-13-qi-9","context":"A 42-year-old patient comes to see you at your office for febrile pharyngeal pain. This lady's main history is a road accident in 2001 with ruptured spleen requiring partial splenectomy, unlabeled episodes of tachycardia, essential hypertension treated with hydrochlorothiazide and chronic alcoholism (8 cans of beer per day). She smokes a pack of cigarettes a day. She is a mother of 4 children but lives alone, custody of her children having been taken away from her. She is currently unemployed (former cleaner), occasionally has paid sex. She has had a fever and throat pain for 24 hours. The throat exam is as follows:","enonce":"Which of the following exams do you perform quickly? ","item":"annales-2019-dp-13","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Cytobacteriological examination of sputum","justification":""},{"idx":1,"correct":true,"proposition":"Search for acid-alcohol-resistant bacilli in sputum","justification":""},{"idx":2,"correct":false,"proposition":"Bronchoalveolar lavage","justification":"If ECBC fails"},{"idx":3,"correct":false,"proposition":"Gastric tubing in search of acid-alcohol-resistant bacilli","justification":"If ECBC fails"},{"idx":4,"correct":true,"proposition":"Chest X-ray","justification":""}],"ts":{"$numberLong":"1665228769750"},"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"}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-13-qi-11","context":"A 42-year-old patient comes to see you at your office for febrile pharyngeal pain. This lady's main history is a road accident in 2001 with ruptured spleen requiring partial splenectomy, unlabeled episodes of tachycardia, essential hypertension treated with hydrochlorothiazide and chronic alcoholism (8 cans of beer per day). She smokes a pack of cigarettes a day. She is a mother of 4 children but lives alone, custody of her children having been taken away from her. She is currently unemployed (former cleaner), occasionally has paid sex. She has had a fever and throat pain for 24 hours. The throat exam is as follows:","enonce":"Which of the following infectious agents can (may) classically be involved in abscessed lung damage?","item":"annales-2019-dp-13","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Staphylococcus aureus"},{"idx":1,"correct":true,"proposition":"Klebsiella pneumoniae"},{"idx":2,"correct":false,"proposition":"Treponema pallidum"},{"idx":3,"correct":false,"proposition":"Pneumocystis jiroveci"},{"idx":4,"correct":true,"proposition":"Fusobacterium necrophorum","justification":"In addition, there is strepto, anaerobes, Pseudomonas, Legionella, ..."}],"ts":{"$numberLong":"1665228769750"},"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":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-13-qi-13","context":"A 42-year-old patient comes to see you at your office for febrile pharyngeal pain. This lady's main history is a road accident in 2001 with ruptured spleen requiring partial splenectomy, unlabeled episodes of tachycardia, essential hypertension treated with hydrochlorothiazide and chronic alcoholism (8 cans of beer per day). She smokes a pack of cigarettes a day. She is a mother of 4 children but lives alone, custody of her children having been taken away from her. She is currently unemployed (former cleaner), occasionally has paid sex. She has had a fever and throat pain for 24 hours. The throat exam is as follows:","enonce":"You also performed a cytobacteriological examination of sputum. Which parameter(s) will make you consider this review to be of quality and reliable? ","item":"annales-2019-dp-13","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Sampling in sputum medium","justification":"It is not a quality criterion"},{"idx":1,"correct":false,"proposition":"Bacterial colonies> 10^3\/mL","justification":"On an ECBC, it's 10^7"},{"idx":2,"correct":false,"proposition":"PNN < 25","justification":"Upper 🤭"},{"idx":3,"correct":true,"proposition":"Epithelial cells < 10","justification":"This question often falls, it is necessary to know these values."},{"idx":4,"correct":true,"proposition":"Monomicrobial","justification":""}],"ts":{"$numberLong":"1665228769750"},"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"}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-13-qi-15","context":"A 42-year-old patient comes to see you at your office for febrile pharyngeal pain. This lady's main history is a road accident in 2001 with ruptured spleen requiring partial splenectomy, unlabeled episodes of tachycardia, essential hypertension treated with hydrochlorothiazide and chronic alcoholism (8 cans of beer per day). She smokes a pack of cigarettes a day. She is a mother of 4 children but lives alone, custody of her children having been taken away from her. She is currently unemployed (former cleaner), occasionally has paid sex. She has had a fever and throat pain for 24 hours. The throat exam is as follows:","enonce":"If, because of the involvement of this anaerobic flora, you decided to include metronidazole in your antibiotic therapy, what adverse effect(s) would you expose the patient? ","item":"annales-2019-dp-13","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Metallic taste in the mouth","justification":""},{"idx":1,"correct":true,"proposition":"Antabuse effect when ingested alcohol","justification":""},{"idx":2,"correct":false,"proposition":"Hypokalaemia in combination with a thiazide diuretic","justification":"Metronidazole is an enzyme inhibitor but does not interact with diuretics."},{"idx":3,"correct":false,"proposition":"Color vision disorder","justification":""},{"idx":4,"correct":true,"proposition":"Neuropathy","justification":""}],"ts":{"$numberLong":"1665228769750"},"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?"}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-13-qi-2","context":"You see in consultation a 57-year-old patient who suffers from epigastric pain progressing by attacks, which lasts several days and is accompanied by nausea. For the last 6 months, these seizures initially recurred once a month. They have now become fortnightly and the patient is forced to restrict his diet because of nausea. There is a progressive weight loss of 7 kg in two years. The patient measures 1m82 and weighs 66 kg. The patient has been an excessive consumer of wine since his military service (one bottle a day) and beer (2 to 3 per day) and has smoked a pack a day since the age of 25. For 6 months this alcohol consumption has been reduced.","enonce":"The pain radiates to the back and is increased by food intake. The stool is not black. The patient does not take antacid. What are or would be the elements in favor of a pancreatic pathology? (one or more correct answers) ","item":"annales-2020-dp-13","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Weight loss","justification":""},{"idx":1,"correct":true,"proposition":"Dorsal irradiation of pain","justification":""},{"idx":2,"correct":true,"proposition":"The triggering of pain by food intake","justification":""},{"idx":3,"correct":false,"proposition":"Nausea","justification":"Symptom really very aspecific."},{"idx":4,"correct":false,"proposition":"A conjunctival pallor","justification":"Pallor = Anemia = Digestive hemorrhage."}],"ts":{"$numberLong":"1665228949807"},"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":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-13-qi-4","context":"You see in consultation a 57-year-old patient who suffers from epigastric pain progressing by attacks, which lasts several days and is accompanied by nausea. For the last 6 months, these seizures initially recurred once a month. They have now become fortnightly and the patient is forced to restrict his diet because of nausea. There is a progressive weight loss of 7 kg in two years. The patient measures 1m82 and weighs 66 kg. The patient has been an excessive consumer of wine since his military service (one bottle a day) and beer (2 to 3 per day) and has smoked a pack a day since the age of 25. For 6 months this alcohol consumption has been reduced.","enonce":"You have an abdominal CT scan of which here is an image: The numbers represent anatomical structures. What is the exact answer(s)? ","item":"annales-2020-dp-13","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"1 represents portal vein","justification":"The portal vein would be more anterior. This is the inferior vena cava."},{"idx":1,"correct":true,"proposition":"2 represents a splenic vessel","justification":"You can follow his trajer to the spleen."},{"idx":2,"correct":true,"proposition":"3 represents intra-pancreatic calcification","justification":""},{"idx":3,"correct":false,"proposition":"4 represents the stomach","justification":"A little too far to the right to be the stomach."},{"idx":4,"correct":false,"proposition":"5 represents the left colonist","justification":"The left colon is just lateral. The 5 represents the stomach."}],"ts":{"$numberLong":"1665228949807"},"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."}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-13-qi-6","context":"You see in consultation a 57-year-old patient who suffers from epigastric pain progressing by attacks, which lasts several days and is accompanied by nausea. For the last 6 months, these seizures initially recurred once a month. They have now become fortnightly and the patient is forced to restrict his diet because of nausea. There is a progressive weight loss of 7 kg in two years. The patient measures 1m82 and weighs 66 kg. The patient has been an excessive consumer of wine since his military service (one bottle a day) and beer (2 to 3 per day) and has smoked a pack a day since the age of 25. For 6 months this alcohol consumption has been reduced.","enonce":"The stool is described by the patient as clear, putty, very foul-smelling and floating. An endoscopic ultrasound of the bile ducts and pancreas, performed secondarily, shows that the pancreatic obstacle is related to fibrosis. There is no lithiasis of the main bile duct. The patient suffers daily from epigastric pain that is relieved only by morphine analgesics. He decreased his beer consumption. There has been an additional weight loss of 2 kg over the past month. What is (are) the factor(s) promoting this weight loss?","item":"annales-2020-dp-13","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Exocrine pancreatic insufficiency","justification":"Malabsorption."},{"idx":1,"correct":true,"proposition":"Taking morphine","justification":"Morphine-induced nausea\/vomiting may contribute to weight loss."},{"idx":2,"correct":true,"proposition":"Pancreatic pain","justification":"Anorexia."},{"idx":3,"correct":true,"proposition":"Decreased beer consumption","justification":""},{"idx":4,"correct":true,"proposition":"Cholestasis","justification":""}],"ts":{"$numberLong":"1665228949807"},"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":""}],"ts":{"$numberLong":"1665228949807"},"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":""}],"ts":{"$numberLong":"1665228949807"},"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":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-13-qi-10","context":"You see in consultation a 57-year-old patient who suffers from epigastric pain progressing by attacks, which lasts several days and is accompanied by nausea. For the last 6 months, these seizures initially recurred once a month. They have now become fortnightly and the patient is forced to restrict his diet because of nausea. There is a progressive weight loss of 7 kg in two years. The patient measures 1m82 and weighs 66 kg. The patient has been an excessive consumer of wine since his military service (one bottle a day) and beer (2 to 3 per day) and has smoked a pack a day since the age of 25. For 6 months this alcohol consumption has been reduced.","enonce":"In this context of chronic pancreatitis, what treatment(s) or complementary measure(s) should be added in addition to its low-fat diet:","item":"annales-2020-dp-13","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Vitamin k","justification":"ADEK vitamins"},{"idx":1,"correct":true,"proposition":"Smoking cessation","justification":""},{"idx":2,"correct":false,"proposition":"Vitamin B12","justification":""},{"idx":3,"correct":true,"proposition":"Pancreatic extracts at every meal","justification":""},{"idx":4,"correct":false,"proposition":"Iron","justification":""}],"ts":{"$numberLong":"1665228949807"},"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"}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-13-qi-12","context":"You see in consultation a 57-year-old patient who suffers from epigastric pain progressing by attacks, which lasts several days and is accompanied by nausea. For the last 6 months, these seizures initially recurred once a month. They have now become fortnightly and the patient is forced to restrict his diet because of nausea. There is a progressive weight loss of 7 kg in two years. The patient measures 1m82 and weighs 66 kg. The patient has been an excessive consumer of wine since his military service (one bottle a day) and beer (2 to 3 per day) and has smoked a pack a day since the age of 25. For 6 months this alcohol consumption has been reduced.","enonce":"Its one-week glycemic record shows the following profile about 3 representative days.\nWhich therapeutic adaptation do you think is the most relevant? (only one answer expected)","item":"annales-2020-dp-13","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Reduction of glargine dose in the evening","justification":"This would allow you to start the day a little higher. Since the morning level and the one to which the patient falls back after taking rapid insulin, this should solve his hypoglycemia 😊 problems"},{"idx":1,"correct":false,"proposition":"Reduction of the insulin dose of breakfast","justification":""},{"idx":2,"correct":false,"proposition":"Moving glargine injection from evening to morning","justification":""},{"idx":3,"correct":false,"proposition":"No therapeutic modification","justification":""},{"idx":4,"correct":false,"proposition":"Slow sugar snack at 10 p.m.","justification":""}],"ts":{"$numberLong":"1665228949807"},"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"}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2022-dp-11-qi-1","context":"A 71-year-old man is referred to the emergency room for right lower back pain, deterioration of the general condition with nausea and vomiting evolving for 72 hours. His history is marked by: Type II diabetes evolving for 15 years treated with metformin 3 g \/ d \/ High blood pressure treated with irbersartan 300 mg \/ d and hydrochlorothiazide and well controlled under treatment for several years \/ An episode of left renal colic 2 years ago with spontaneous elimination of the stone \/ A smoking weaned for 5 years evaluated at 30 pack-years \/ Obesity with a weight of 90kg for 1m70. He took ibuprofen for lumbago for 48 hours a few days ago which he stopped due to the occurrence of epigastralgia.","enonce":" What are the elements of the clinical examination to assess the initial severity? (one or more correct answers)","item":"annales-2022-dp-11","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Temperature measurement","justification":""},{"idx":1,"correct":false,"proposition":"Assessment of pain intensity","justification":""},{"idx":2,"correct":true,"proposition":"Taking blood pressure","justification":""},{"idx":3,"correct":false,"proposition":"Lumbar contact tracing","justification":""},{"idx":4,"correct":true,"proposition":"Evaluation of diuresis","justification":""}],"ts":{"$numberLong":"1665243680997"},"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":""}],"ts":{"$numberLong":"1665243680997"},"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":""}],"ts":{"$numberLong":"1665243680997"},"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":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-11-qi-5","context":"A 71-year-old man is referred to the emergency room for right lower back pain, deterioration of the general condition with nausea and vomiting evolving for 72 hours. His history is marked by: Type II diabetes evolving for 15 years treated with metformin 3 g \/ d \/ High blood pressure treated with irbersartan 300 mg \/ d and hydrochlorothiazide and well controlled under treatment for several years \/ An episode of left renal colic 2 years ago with spontaneous elimination of the stone \/ A smoking weaned for 5 years evaluated at 30 pack-years \/ Obesity with a weight of 90kg for 1m70. He took ibuprofen for lumbago for 48 hours a few days ago which he stopped due to the occurrence of epigastralgia.","enonce":" What are the 3 most likely diagnoses in front of this table?","item":"annales-2022-dp-11","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Sigmoiditis","justification":""},{"idx":1,"correct":true,"proposition":"Acute pyelonephritis","justification":""},{"idx":2,"correct":false,"proposition":"Acute tubular necrosis","justification":""},{"idx":3,"correct":true,"proposition":"Febrile renal colic","justification":""},{"idx":4,"correct":true,"proposition":"Renal infarction","justification":""}],"ts":{"$numberLong":"1665243680997"},"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":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-11-qi-7","context":"A 71-year-old man is referred to the emergency room for right lower back pain, deterioration of the general condition with nausea and vomiting evolving for 72 hours. His history is marked by: Type II diabetes evolving for 15 years treated with metformin 3 g \/ d \/ High blood pressure treated with irbersartan 300 mg \/ d and hydrochlorothiazide and well controlled under treatment for several years \/ An episode of left renal colic 2 years ago with spontaneous elimination of the stone \/ A smoking weaned for 5 years evaluated at 30 pack-years \/ Obesity with a weight of 90kg for 1m70. He took ibuprofen for lumbago for 48 hours a few days ago which he stopped due to the occurrence of epigastralgia.","enonce":" An arterial blood gas shows: pH 7.35, PaCO 2 37 mmHg, PaO 2 75 mmHg, alkaline reserve 18 mmol\/L, lactic acid 3 mmol\/L. What is your initial management? (one or more correct answers)","item":"annales-2022-dp-11","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Alkalinization by sodium bicarbonate 84\/1000","justification":""},{"idx":1,"correct":true,"proposition":"Discontinuation of metformin","justification":""},{"idx":2,"correct":true,"proposition":"Discontinuation of irbesartan","justification":""},{"idx":3,"correct":true,"proposition":"Vascular filling by NaCl solute 0.9%","justification":""},{"idx":4,"correct":false,"proposition":"Introduction of loop diuretic to revive diuresis","justification":""}],"ts":{"$numberLong":"1665243680997"},"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":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-11-qi-9","context":"A 71-year-old man is referred to the emergency room for right lower back pain, deterioration of the general condition with nausea and vomiting evolving for 72 hours. His history is marked by: Type II diabetes evolving for 15 years treated with metformin 3 g \/ d \/ High blood pressure treated with irbersartan 300 mg \/ d and hydrochlorothiazide and well controlled under treatment for several years \/ An episode of left renal colic 2 years ago with spontaneous elimination of the stone \/ A smoking weaned for 5 years evaluated at 30 pack-years \/ Obesity with a weight of 90kg for 1m70. He took ibuprofen for lumbago for 48 hours a few days ago which he stopped due to the occurrence of epigastralgia.","enonce":" What is decisive for emergency care?","item":"annales-2022-dp-11","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Presence of eosinophilia","justification":""},{"idx":1,"correct":true,"proposition":"Renal vesicogram ultrasound","justification":""},{"idx":2,"correct":false,"proposition":"Presence of hepatic cytolysis","justification":""},{"idx":3,"correct":false,"proposition":"Renal MRI","justification":""},{"idx":4,"correct":false,"proposition":"Uroscanner","justification":""}],"ts":{"$numberLong":"1665243680997"},"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":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-11-qi-11","context":"A 71-year-old man is referred to the emergency room for right lower back pain, deterioration of the general condition with nausea and vomiting evolving for 72 hours. His history is marked by: Type II diabetes evolving for 15 years treated with metformin 3 g \/ d \/ High blood pressure treated with irbersartan 300 mg \/ d and hydrochlorothiazide and well controlled under treatment for several years \/ An episode of left renal colic 2 years ago with spontaneous elimination of the stone \/ A smoking weaned for 5 years evaluated at 30 pack-years \/ Obesity with a weight of 90kg for 1m70. He took ibuprofen for lumbago for 48 hours a few days ago which he stopped due to the occurrence of epigastralgia.","enonce":" The electrocardiogram performed is as follows: What are the exact proposals? (one or more correct answers)","item":"annales-2022-dp-11","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Supraventricular tachycardia","justification":""},{"idx":1,"correct":false,"proposition":"Right axis of QRS","justification":""},{"idx":2,"correct":true,"proposition":"Atrial fibrillation","justification":""},{"idx":3,"correct":false,"proposition":"Ventricular tachycardia","justification":""},{"idx":4,"correct":false,"proposition":"Ear fluttering","justification":""}],"ts":{"$numberLong":"1665243680997"},"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":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-11-qi-13","context":"A 71-year-old man is referred to the emergency room for right lower back pain, deterioration of the general condition with nausea and vomiting evolving for 72 hours. His history is marked by: Type II diabetes evolving for 15 years treated with metformin 3 g \/ d \/ High blood pressure treated with irbersartan 300 mg \/ d and hydrochlorothiazide and well controlled under treatment for several years \/ An episode of left renal colic 2 years ago with spontaneous elimination of the stone \/ A smoking weaned for 5 years evaluated at 30 pack-years \/ Obesity with a weight of 90kg for 1m70. He took ibuprofen for lumbago for 48 hours a few days ago which he stopped due to the occurrence of epigastralgia.","enonce":" A pelvic abdomino scan was performed: What are the exact proposals? (one or more correct answers)","item":"annales-2022-dp-11","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"examination shows kidney cysts of the right kidney","justification":""},{"idx":1,"correct":false,"proposition":"Examination shows lithiasis enclosed in the right kidney","justification":""},{"idx":2,"correct":false,"proposition":"the right pyelocalcial cavities are dilated","justification":""},{"idx":3,"correct":true,"proposition":"examination shows an area of hypoperfusion of the right kidney","justification":""},{"idx":4,"correct":true,"proposition":"It is a CT scan injected at arterial time","justification":""}],"ts":{"$numberLong":"1665243680997"},"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":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-11-qi-15","context":"A 71-year-old man is referred to the emergency room for right lower back pain, deterioration of the general condition with nausea and vomiting evolving for 72 hours. His history is marked by: Type II diabetes evolving for 15 years treated with metformin 3 g \/ d \/ High blood pressure treated with irbersartan 300 mg \/ d and hydrochlorothiazide and well controlled under treatment for several years \/ An episode of left renal colic 2 years ago with spontaneous elimination of the stone \/ A smoking weaned for 5 years evaluated at 30 pack-years \/ Obesity with a weight of 90kg for 1m70. He took ibuprofen for lumbago for 48 hours a few days ago which he stopped due to the occurrence of epigastralgia.","enonce":" What care would be relevant in the immediate future? (one or more correct answers)","item":"annales-2022-dp-11","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Antiplatelet","justification":""},{"idx":1,"correct":false,"proposition":"Preventive anticoagulation","justification":""},{"idx":2,"correct":true,"proposition":"Effective anticoagulation","justification":""},{"idx":3,"correct":false,"proposition":"Electrical cardioversion","justification":""},{"idx":4,"correct":false,"proposition":"Drug cardioversion","justification":""}],"ts":{"$numberLong":"1665243680997"},"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":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-17-qi-2","context":"You receive in consultation a woman of 52 years, second gesture, nulliparous, not taking contraception. Its body mass index is 42 kg\/m2. She has high blood pressure well controlled by perindopril, amlodipine and indapamide. She also has hypothyroidism of undetermined etiology requiring long-term thyroid hormone intake and also well-balanced type 2 diabetes under diet alone. She had surgery for a total left hip replacement 4 years ago. She has a family history of colon cancer in her father, from whom he died at the age of 59. She also reported breast cancer in her mother at the age of 47 and her maternal aunt at the age of 60.","enonce":" This woman is indeed menopausal. She wants hormone replacement therapy to relieve her hot flashes. You discuss this treatment with her. What are the exact claims? (one or more correct answers)","item":"annales-2022-dp-17","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"estrogen can be administered dermally","justification":""},{"idx":1,"correct":false,"proposition":"Estrogen therapy has no impact on lipid metabolism","justification":""},{"idx":2,"correct":true,"proposition":"a mammogram is required","justification":""},{"idx":3,"correct":true,"proposition":"Progestogen therapy should be combined with estrogen therapy","justification":""},{"idx":4,"correct":true,"proposition":"Estrogen therapy may limit vaginal atrophy","justification":""}],"ts":{"$numberLong":"1665243680997"},"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":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-17-qi-4","context":"You receive in consultation a woman of 52 years, second gesture, nulliparous, not taking contraception. Its body mass index is 42 kg\/m2. She has high blood pressure well controlled by perindopril, amlodipine and indapamide. She also has hypothyroidism of undetermined etiology requiring long-term thyroid hormone intake and also well-balanced type 2 diabetes under diet alone. She had surgery for a total left hip replacement 4 years ago. She has a family history of colon cancer in her father, from whom he died at the age of 59. She also reported breast cancer in her mother at the age of 47 and her maternal aunt at the age of 60.","enonce":" Her diabetes is therefore poorly balanced, she has mixed dyslipidemia and chronic renal failure. In addition, she is afraid of having osteoporosis because she complains of pain in her right knee, without any notion of trauma. These pains have been progressing for several months, with worsening in recent days. They radiate little, occur at the end of the day and prevent the patient from sitting for a long time. In view of the clinical picture, you suspect right gonarthrosis. What additional tests do you prescribe as a first line? (one or more correct answers)","item":"annales-2022-dp-17","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"X-ray of the knees (face and profile)","justification":""},{"idx":1,"correct":false,"proposition":"bone scintigraphy","justification":""},{"idx":2,"correct":false,"proposition":"computed tomography (CT) scan of the knee","justification":""},{"idx":3,"correct":false,"proposition":"magnetic resonance imaging (MRI) of the right knee","justification":""},{"idx":4,"correct":false,"proposition":"ultrasound of the right knee","justification":""}],"ts":{"$numberLong":"1665243680997"},"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":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-17-qi-6","context":"You receive in consultation a woman of 52 years, second gesture, nulliparous, not taking contraception. Its body mass index is 42 kg\/m2. She has high blood pressure well controlled by perindopril, amlodipine and indapamide. She also has hypothyroidism of undetermined etiology requiring long-term thyroid hormone intake and also well-balanced type 2 diabetes under diet alone. She had surgery for a total left hip replacement 4 years ago. She has a family history of colon cancer in her father, from whom he died at the age of 59. She also reported breast cancer in her mother at the age of 47 and her maternal aunt at the age of 60.","enonce":" Gonarthrosis is confirmed, what care can you offer? (one or more correct answers)","item":"annales-2022-dp-17","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Oral corticosteroid therapy","justification":""},{"idx":1,"correct":false,"proposition":"Oral nonsteroidal anti-inflammatory drug","justification":""},{"idx":2,"correct":true,"proposition":"Dietary management","justification":""},{"idx":3,"correct":true,"proposition":"Tier 1 analgesic","justification":""},{"idx":4,"correct":true,"proposition":"moderate physical activity outside of painful periods","justification":""}],"ts":{"$numberLong":"1665243680997"},"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":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-17-qi-8","context":"You receive in consultation a woman of 52 years, second gesture, nulliparous, not taking contraception. Its body mass index is 42 kg\/m2. She has high blood pressure well controlled by perindopril, amlodipine and indapamide. She also has hypothyroidism of undetermined etiology requiring long-term thyroid hormone intake and also well-balanced type 2 diabetes under diet alone. She had surgery for a total left hip replacement 4 years ago. She has a family history of colon cancer in her father, from whom he died at the age of 59. She also reported breast cancer in her mother at the age of 47 and her maternal aunt at the age of 60.","enonce":" Breast ultrasound showed the existence of a hypoechoic tumor of 10 mm in the right infero-internal quadrant, poorly limited, with a large axenon parallel to the cutaneous plane and without associated axillary lymphadenopathy. What explorations do you prescribe? (one or more correct answers)","item":"annales-2022-dp-17","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Percutaneous biopsy samples","justification":""},{"idx":1,"correct":false,"proposition":"A positron emission tomography (PET CT) scan with 18 fluorodeoxy glucose","justification":""},{"idx":2,"correct":false,"proposition":"A plasma assay of the CA 15.3 marker","justification":""},{"idx":3,"correct":false,"proposition":"A thoraco-abdomino-pelvic CT scan","justification":""},{"idx":4,"correct":false,"proposition":"A brain scan","justification":""}],"ts":{"$numberLong":"1665243680997"},"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":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-17-qi-10","context":"You receive in consultation a woman of 52 years, second gesture, nulliparous, not taking contraception. Its body mass index is 42 kg\/m2. She has high blood pressure well controlled by perindopril, amlodipine and indapamide. She also has hypothyroidism of undetermined etiology requiring long-term thyroid hormone intake and also well-balanced type 2 diabetes under diet alone. She had surgery for a total left hip replacement 4 years ago. She has a family history of colon cancer in her father, from whom he died at the age of 59. She also reported breast cancer in her mother at the age of 47 and her maternal aunt at the age of 60.","enonce":" The patient had a right partial mastectomy with sentinel lymph node retrieval. The pathological results objectified a non-specific invasive mammary carcinoma of 8 mm of the infero-internal quadrant; ER (30%), PR (5%), HER2 negative, Ki 67=10% and an axillary sentinel lymph nodeunharmed. External beam radiation therapy was performed on the right breast. Treatment with anti-aromatase is prescribed. What are the exact statements about this adjuvant drug therapy? (one or more correct answers)","item":"annales-2022-dp-17","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"It is associated with an increased osteoporotic risk","justification":""},{"idx":1,"correct":false,"proposition":"It is associated with an increased thromboembolic risk","justification":""},{"idx":2,"correct":true,"proposition":"It is associated with an increased risk of ovarian cancer","justification":""},{"idx":3,"correct":true,"proposition":"It works by blocking the transformation of androgens into estrogens","justification":""},{"idx":4,"correct":false,"proposition":"it is to be continued for at least 5 years","justification":""}],"ts":{"$numberLong":"1665243680997"},"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":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-17-qi-12","context":"You receive in consultation a woman of 52 years, second gesture, nulliparous, not taking contraception. Its body mass index is 42 kg\/m2. She has high blood pressure well controlled by perindopril, amlodipine and indapamide. She also has hypothyroidism of undetermined etiology requiring long-term thyroid hormone intake and also well-balanced type 2 diabetes under diet alone. She had surgery for a total left hip replacement 4 years ago. She has a family history of colon cancer in her father, from whom he died at the age of 59. She also reported breast cancer in her mother at the age of 47 and her maternal aunt at the age of 60.","enonce":" This woman is suspected to have a genetic predisposition to cancer. What are the exact statements about an oncogenetic consultation in his case? (one or more correct answers)","item":"annales-2022-dp-17","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"His age, on its own, is sufficient to indicate an oncogenetic consultation.","justification":""},{"idx":1,"correct":false,"proposition":"The pathological characteristics of her breast cancer, alone, are sufficient to indicate an oncogenetic consultation.","justification":""},{"idx":2,"correct":true,"proposition":"his family history of breast cancer, on its own, is sufficient to indicate an oncogenetic consultation.","justification":""},{"idx":3,"correct":true,"proposition":"  in his case, a BRCA mutation may be present","justification":""},{"idx":4,"correct":true,"proposition":"in his case, a mutation predisposing to familial colon cancer syndrome (Lynch syndrome) may be present","justification":""}],"ts":{"$numberLong":"1665243680997"},"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":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
+{"_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"}