diff --git "a/english/dp_train.jsonl" "b/english/dp_train.jsonl"
--- "a/english/dp_train.jsonl"
+++ "b/english/dp_train.jsonl"
@@ -1,935 +1,935 @@
-{"_id":"annales-2018-dp-1-qi-1","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"What are the elements (present or to be sought at the interrogation and clinical examination) that can evoke a malignant tumor of the kidney? (one or more correct answers) ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Smoking","justification":"Tobacco is indeed a risk factor for kidney (as well as bladder) cancer."},{"idx":1,"correct":true,"proposition":"Chronic high blood pressure","justification":""},{"idx":2,"correct":false,"proposition":"Long-term calcium channel blocker treatment","justification":""},{"idx":3,"correct":false,"proposition":"A family history of multiple endocrine neoplasia","justification":""},{"idx":4,"correct":true,"proposition":"Low back pain","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-1-qi-2","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"Which exam(s) are you asking for as a first line? ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Urinary cytology with pathological examination","justification":"It is indeed a first-line examination"},{"idx":1,"correct":true,"proposition":"Cytobacteriological examination of urine","justification":""},{"idx":2,"correct":false,"proposition":"Serum erythropoietin assay","justification":""},{"idx":3,"correct":true,"proposition":"Abdominopelvic CT scan with and without contrast injection","justification":""},{"idx":4,"correct":false,"proposition":"Ultrasound-guided puncture of the mass","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-1-qi-3","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"On the cut shown below, what are the true propositions?  (one or more correct answers) ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"This is an abdominal CT scan with injection","justification":""},{"idx":1,"correct":false,"proposition":"This is a coronal cup","justification":"Axial cut"},{"idx":2,"correct":false,"proposition":"Structure number 1 is the inferior vena cava","justification":"Aorta"},{"idx":3,"correct":true,"proposition":"The cut passes through the third duodenum","justification":""},{"idx":3,"correct":false,"proposition":"The number 2 corresponds to the inferior mesenteric artery","justification":"superior"}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-1-qi-4","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"What are the real propositions? (one or more correct answers) ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The patient must receive red blood cells","justification":""},{"idx":1,"correct":false,"proposition":"The patient must receive platelet pellets","justification":""},{"idx":2,"correct":false,"proposition":"In case of transfusion of red blood cells, you would prescribe O-negative pellets","justification":""},{"idx":3,"correct":false,"proposition":"A search result for irregular agglutinins less than 48 h old must be available","justification":""},{"idx":4,"correct":false,"proposition":"Since 2003, there has been no risk of transmission of infectious pathogens through red blood cell transfusion","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-1-qi-5","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"What is the real proposal(s)? ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"This is acute renal failure","justification":""},{"idx":1,"correct":false,"proposition":"The glomerular filtration rate must be recalculated","justification":""},{"idx":2,"correct":false,"proposition":"An obstacle on the contralateral kidney is likely","justification":""},{"idx":3,"correct":true,"proposition":"It may be functional renal failure","justification":""},{"idx":4,"correct":true,"proposition":"An ionogram should be prescribed on a urine sample","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-1-qi-6","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"What are the exact proposals? (one or more correct answers) ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"He has moderate chronic renal failure","justification":""},{"idx":1,"correct":true,"proposition":"His antihypertensive treatment must include an inhibitor of the renin-angiotensin system","justification":""},{"idx":2,"correct":false,"proposition":"The LDL cholesterol target to be achieved is 1.3 g\/L","justification":""},{"idx":3,"correct":false,"proposition":"He must follow a diet containing no more than 1.5 g\/kg of protein weight","justification":""},{"idx":4,"correct":false,"proposition":"It is necessary to advocate a diet low in fast sugars","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-1-qi-7","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"What risk(s) does he run? ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Gradual decrease in diuresis","justification":""},{"idx":1,"correct":true,"proposition":"Increased cardiovascular risk","justification":""},{"idx":2,"correct":true,"proposition":"Hyperphosphoremia","justification":""},{"idx":3,"correct":true,"proposition":"Erectile dysfunction","justification":""},{"idx":4,"correct":true,"proposition":"Contralateral kidney cancer","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-1-qi-8","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"What is the true answer(s)? ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"The ALD file is completed by the patient and validated by the medical specialist","justification":""},{"idx":1,"correct":true,"proposition":"The attending physician must specify in the request the protocol of care envisaged including treatments, examinations and consultations","justification":""},{"idx":2,"correct":true,"proposition":"The care protocol must be validated by the medical officer of the Health Insurance","justification":""},{"idx":3,"correct":false,"proposition":"In case of coverage in ALD, remains the responsibility of the patient only the co-payment","justification":""},{"idx":4,"correct":false,"proposition":"The third-party payer is the part of the care paid by the insured whether or not he is registered in ALD","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-1-qi-9","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"What is your interpretation of the electrocardiogram below? ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Sinus rhythm","justification":""},{"idx":1,"correct":false,"proposition":"Sino-auricular block","justification":""},{"idx":2,"correct":false,"proposition":"T-waves suggestive of hyperkalemia","justification":""},{"idx":3,"correct":false,"proposition":"Expanded QRS Complexes","justification":""},{"idx":4,"correct":true,"proposition":"Left ventricular hypertrophy","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-1-qi-10","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"To reduce edematous syndrome, what do you recommend at this stage? (one or more correct answers) ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"A low-salt diet (less than 6 g\/d)","justification":""},{"idx":1,"correct":false,"proposition":"Water restriction","justification":""},{"idx":2,"correct":true,"proposition":"A loop diuretic (furosemide)","justification":""},{"idx":3,"correct":false,"proposition":"A thiazide diuretic (hydrochlorothiazide)","justification":""},{"idx":4,"correct":false,"proposition":"Blood ultrafiltration (start of hemodialysis)","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-1-qi-11","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"What are the possible cause(s) in the context of the new biological abnormality observed? ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Excessive calcium intake","justification":""},{"idx":1,"correct":false,"proposition":"Taking furosemide","justification":""},{"idx":2,"correct":true,"proposition":"Chronic renal failure","justification":"This is a POSSIBLE (but rare) cause of hypercalcemia by tertiary hyperparathyroidism, one really needs to read the statements carefully and take them to the first degree. It should be remembered, however, that chronic renal failure is mainly a source of hypocalcaemia."},{"idx":3,"correct":false,"proposition":"Secondary hyperparathyroidism","justification":"Normal serum calcium"},{"idx":4,"correct":true,"proposition":"Bone metastases from kidney cancer","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-1-qi-12","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"What additional examination(s) do you recommend to explore this biological anomaly? ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Ionized serum calcium","justification":""},{"idx":1,"correct":false,"proposition":"Test de PAK","justification":""},{"idx":2,"correct":true,"proposition":"PTH assay","justification":""},{"idx":3,"correct":false,"proposition":"PTHrp assay","justification":""},{"idx":4,"correct":true,"proposition":"Bone scintigraphy","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-1-qi-13","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"Which proposals are correct? (one or more correct answers) ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Metastatic cancer is a contraindication to dialysis","justification":""},{"idx":1,"correct":false,"proposition":"Haemodialysis confers survival advantage over peritoneal dialysis","justification":""},{"idx":2,"correct":false,"proposition":"The preparation of an arteriovenous fistula (AVF) is contraindicated given the prognosis","justification":""},{"idx":3,"correct":true,"proposition":"A tunneled central venous catheter may be placed to initiate hemodialysis","justification":""},{"idx":4,"correct":false,"proposition":"A transplant from a cadaveric donor must be discussed","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-1-qi-14","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"In general, regarding living donors, what are the real proposals? (one or more correct answers) ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Only people with a genetic link to the recipient can be donors","justification":""},{"idx":1,"correct":true,"proposition":"Transplantation can be done in incompatible ABO condition","justification":""},{"idx":2,"correct":false,"proposition":"Rhesus compatibility must be respected","justification":""},{"idx":3,"correct":false,"proposition":"HLA incompatibility between donor and recipient is a formal contraindication","justification":""},{"idx":4,"correct":false,"proposition":"The donor is remunerated on a basis proportional to the recipient's waiting time","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-2-qi-1","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"What additional examination(s) do you prescribe in early pregnancy? ","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Cervico-uterine smear","justification":""},{"idx":1,"correct":true,"proposition":"Hbs antigen","justification":""},{"idx":2,"correct":true,"proposition":"Fasting blood glucose","justification":""},{"idx":3,"correct":false,"proposition":"Pulmonary function tests","justification":""},{"idx":4,"correct":true,"proposition":"Cytobacteriological examination of urine","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-2-qi-2","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"Regarding trisomy 21 screening in this case, what is (are) the exact proposal(s)? ","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Nuchal translucency measurement is performed on an axial section of the fetus","justification":""},{"idx":1,"correct":true,"proposition":"Combined first trimester screening takes into account gestational age","justification":""},{"idx":2,"correct":false,"proposition":"Integrated sequential screening of the second trimester is not possible due to Turner syndrome","justification":""},{"idx":3,"correct":false,"proposition":"The patient's age is taken into account for the calculation of the combined risk of the first trimester","justification":""},{"idx":4,"correct":false,"proposition":"Total hCG is considered for combined first trimester screening","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-2-qi-3","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"What is the exact proposal(s)? ","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"This is a toxoplasma seroconversion","justification":""},{"idx":1,"correct":true,"proposition":"The initiation of treatment with spiramycin is lawful","justification":""},{"idx":2,"correct":true,"proposition":"Amniocentesis should be offered at least 4 weeks after the expected date of seroconversion","justification":""},{"idx":3,"correct":false,"proposition":"IgG avidity test is indicated","justification":""},{"idx":4,"correct":false,"proposition":"Cross-reaction with other infectious agents may explain this serological result","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-2-qi-4","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"You start treatment with spiramycin. Regarding this molecule and the pharmacological class to which it belongs, which is (are) the exact proposal(s)?  What is the exact proposal(s)? B. The genome of ","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Spiramycin has a parasiticidal action on Toxoplasma gondii","justification":"Macrolides are parasitostatic"},{"idx":1,"correct":true,"proposition":"Spiramycin acts by inhibition of bacterial proteins by binding to a ribosomal subunit"},{"idx":2,"correct":true,"proposition":"Spiramycin is active on Mycoplasma hominis"},{"idx":3,"correct":true,"proposition":"P. aeruginosa is naturally resistant"},{"idx":4,"correct":true,"proposition":"The therapeutic class is used in the treatment of pertussis"}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-2-qi-5","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"You decide to look for mother-to-fetal transmission of T. gondii. What are the exact proposal(s)?","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"You perform a choriocentesis","justification":""},{"idx":1,"correct":true,"proposition":"The genome is sought in amniotic fluid","justification":"By amniocentesis"},{"idx":2,"correct":false,"proposition":"A search for specific IgG is performed on fetal blood","justification":""},{"idx":3,"correct":false,"proposition":"Chorioretinitis should be tested by fetal ultrasound","justification":""},{"idx":4,"correct":false,"proposition":"Anemia should be sought by measuring brain velocities in Doppler","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-2-qi-6","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"You perform an amniocentesis. The same evening, the patient comes to see you for abdominal pain that has lasted for several hours. There is no vaginal discharge and no bleeding. The patient is apyretic and normotensive. The cervix is shortened to the vaginal touch and measures 18mm. What treatment(s) do you introduce? ","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Betamethasone","justification":""},{"idx":1,"correct":true,"proposition":"Continuation of spiramycin treatment","justification":""},{"idx":2,"correct":false,"proposition":"Indomethacin","justification":""},{"idx":3,"correct":true,"proposition":"Atosiban","justification":""},{"idx":4,"correct":true,"proposition":"Magnesium sulphate","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-2-qi-7","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"After 24 hours of hospitalization, the patient notices losses of smelly fluid through the vagina. Uterine contractions have resumed and are painful. The temperature is 39.3°C.  She gets chills. Cardiotocographic recording shows fetal tachycardia and 5 uterine contractions every 10 minutes. What is the most likely diagnosis?","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Acute appendicitis","justification":""},{"idx":1,"correct":false,"proposition":"Acute pyelonephritis","justification":""},{"idx":2,"correct":false,"proposition":"Listeriosis","justification":""},{"idx":3,"correct":false,"proposition":"Toxoplasma sepsis","justification":""},{"idx":4,"correct":true,"proposition":"Chorioamnionitis","justification":"Most likely given the context (amniocentesis, fever)."}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-2-qi-8","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"In front of this chorioamnionitis and the presence of fetal heart rhythm abnormalities, you perform an emergency caesarean section under general anesthesia. As soon as the child is extracted, heavy bleeding of endouterine origin is observed. Manual delivery of the placenta is performed and the hysterotomy is sutured. The uterus remains soft and significant bleeding persists externalized vaginally despite the infusion of oxytocics. The patient is hemodynamically stable. What therapeutic option(s) can be used in this situation? ","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Mifepristone infusion","justification":""},{"idx":1,"correct":true,"proposition":"Ligation of uterine arteries","justification":""},{"idx":2,"correct":false,"proposition":"Methotrexate infusion","justification":""},{"idx":3,"correct":true,"proposition":"Sulprostone infusion","justification":""},{"idx":4,"correct":false,"proposition":"Ligation of the external iliac arteries","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-2-qi-9","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"An infusion of sulprostone is initiated. One Hemocue reveals a hemoglobin level of 6 g\/dL. Blood loss is estimated at 1500 ml. Blood pressure is 100\/60 and heart rate is 130 beats per minute (bpm). A biological assessment is carried out. The anesthesiologist orders labile blood products in a life-threatening emergency. After 30 minutes, the bleeding seems to dry up and the results of the laboratory workup are available: Leukocytes 15.2 G\/L. Platelets 70 G\/L. Haemoglobin 5.7 g\/dL. Prothrombin level 60%. Activated cephalin time 32\/30. Fibrinogenemia 0.5 g\/L. D-Dimers elevated. Which of the elements of this assessment is included in the definition of biological disseminated intravascular coagulation (DIC)? ","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Platelets","justification":""},{"idx":1,"correct":false,"proposition":"Leukocytes","justification":""},{"idx":2,"correct":true,"proposition":"Fibrinogen","justification":""},{"idx":3,"correct":true,"proposition":"D-dimer","justification":""},{"idx":4,"correct":false,"proposition":"Haemoglobin","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-2-qi-10","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"Taking into account the biological assessment, a transfusion of a platelet concentrate and 4 red blood cells is performed as well as an injection of 1.5 g of fibrinogen. One hour after birth, the bleeding has now dried up. The patient is monitored for 3 hours in the recovery room before being transferred to intensive care. The caesarean section allowed the birth of a girl weighing 790 grams who was immediately supported by the neonatal team. The clinical examination at 5 minutes of life is as follows: respiratory rate 70 \/ minute, intercostal and suprasternal pull, intense xyphoidian funnel, moderate fluttering of the wings of the nose, expiratory whining with the stethoscope, paradoxical respiration, generalized cyanosis, hypotonia, oxygen requirements (02) at 50% to maintain a 90% saturometry. About the neonatal clinical condition, which is the exact proposal(s)?","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"This is transient respiratory distress","justification":""},{"idx":1,"correct":false,"proposition":"The Apgar score is not interpretable in case of prematurity","justification":""},{"idx":2,"correct":true,"proposition":"This child's oxygen needs are a sign of severity","justification":""},{"idx":3,"correct":true,"proposition":"Silverman's score is 8","justification":""},{"idx":4,"correct":false,"proposition":"Generalized cyanosis is in favor of anemia of the newborn","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-2-qi-11","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"The child's respiratory condition improves but after 36 hours in neonatology, his condition deteriorates sharply. A chest X-ray is performed. What diagnosis(s) can you retain from the interpretation of this shot?","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Left fluid pleural effusion","justification":""},{"idx":1,"correct":false,"proposition":"Left retrocardiac atelectasis","justification":""},{"idx":2,"correct":true,"proposition":"Right pneumothorax","justification":""},{"idx":3,"correct":false,"proposition":"Left diaphragmatic hernia","justification":""},{"idx":4,"correct":false,"proposition":"Right pneumoperitoneum","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-2-qi-12","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"You diagnose a right pneumothorax. After exsufflation of the latter, the respiratory condition of the child improves markedly. In addition, at 48 hours of the caesarean section, the mother complains of chest pain. In this patient, which pathology(s) should you eliminate first? ","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Acute cardiogenic edema","justification":""},{"idx":1,"correct":true,"proposition":"Aortic dissection","justification":""},{"idx":2,"correct":false,"proposition":"Bacterial pneumonitis","justification":""},{"idx":3,"correct":false,"proposition":"Pericarditis","justification":""},{"idx":4,"correct":true,"proposition":"Pulmonary embolism","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-2-qi-13","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"In addition to the chest doubt, the patient complains of dyspnea. Blood pressure is at 130\/70 mmHg. The pulses are symmetrical. The temperature is 37.5 ° C.  You decide to immediately perform an emergency pulmonary angiography. What anomaly(s) do you identify on these 3 shots? ","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Dilation of the left ventricle","justification":""},{"idx":1,"correct":false,"proposition":"Ascending aorta dissection","justification":""},{"idx":2,"correct":true,"proposition":"Acute pulmonary heart","justification":""},{"idx":3,"correct":true,"proposition":"Bilateral pulmonary embolism","justification":""},{"idx":4,"correct":false,"proposition":"Pneumomediastinum","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-2-qi-14","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"A pulmonary embolism is diagnosed. Heparin therapy at curative dose is introduced. The patient is transferred back to the maternity ward after 48 hours. She wants to breastfeed but worries because she has cold sores. What do you say about breastfeeding? (one or more correct answers) ","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Breastfeeding is possible despite heparin treatment","justification":""},{"idx":1,"correct":false,"proposition":"Breastfeeding is not possible, as the child is premature","justification":""},{"idx":2,"correct":false,"proposition":"Herpes labialis contraindicates breastfeeding","justification":""},{"idx":3,"correct":false,"proposition":"She won't have a milk rush due to Turner syndrome","justification":""},{"idx":4,"correct":false,"proposition":"Breastfeeding is not recommended in this patient due to complications of childbirth","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-3-qi-1","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"For the evaluation of dependence, which of the following proposals, which corresponds to an instrumental function? ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Wash","justification":""},{"idx":1,"correct":true,"proposition":"Shopping","justification":""},{"idx":2,"correct":true,"proposition":"Prepare a meal","justification":""},{"idx":3,"correct":false,"proposition":"Dress","justification":""},{"idx":4,"correct":true,"proposition":"Manage your medications","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-3-qi-2","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"A dependent patient can benefit from the personalized autonomy allowance.  Select the right proposal(s) from the following: ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"It concerns patients over 60 years of age","justification":""},{"idx":1,"correct":false,"proposition":"It is assigned to GIR 5 and 6 according to the AGGIR grid","justification":""},{"idx":2,"correct":true,"proposition":"Its amount depends on the level of dependency","justification":""},{"idx":3,"correct":true,"proposition":"Its amount depends on individual income","justification":""},{"idx":4,"correct":true,"proposition":"It also concerns patients in nursing homes","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-3-qi-3","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"The IADL (Instrumental activities of daily living) scale is 6\/8. The patient is not very informative, but she says she is tired as soon as she tries to make an effort. She comes accompanied by her daughter who finds her mother sad, and who mentions the progressive appearance of anterograde memory disorders, forcing her to note the information. She has trouble finding certain objects, or the names of her children that she sometimes confords, which saddens her. A month ago, she got lost in a neighborhood she knew well before, which worried her daughter and justified the consultation. The neurological examination is normal, without pyramidal syndrome or parkinsonism. The MMS is at 23\/30, with a reminder of the 3 words at 2\/3. Regarding the evaluation of recent memory in the neuropsychological assessment, the encoding is normal but the patient has a deficit of free recall well corrected by the indication (reactivity 87.5%). The Front Efficiency Fast Battery (BREF) is 15\/18. You mention a major neurocognitive disorder according to DSM 5. Which of the following criterion(s) are actually part of it? ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Slow progressive evolution","justification":""},{"idx":1,"correct":true,"proposition":"Decline in at least one cognitive domain","justification":""},{"idx":2,"correct":true,"proposition":"Memory impairment","justification":""},{"idx":3,"correct":true,"proposition":"Interference of cognitive impairment with autonomy","justification":""},{"idx":4,"correct":false,"proposition":"Worsening of disorders during confusional episodes","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-3-qi-4","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"Brain MRI shows Fazekas stage III vascular leukopathy, with two lacunar ischemic vascular sequelae, as well as Scheltens stage I hippocampal atrophy. The neuropsychological assessment shows a visuo-verbal impairment of subcortical profile, and a dyseexecutive syndrome. Which of the following diagnose(s) do you mention? ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Alzheimer's disease","justification":""},{"idx":1,"correct":true,"proposition":"Cerebrovascular disease","justification":""},{"idx":2,"correct":false,"proposition":"Chronic hydrocephalus","justification":""},{"idx":3,"correct":true,"proposition":"Depression","justification":""},{"idx":4,"correct":false,"proposition":"Frontotemporal lobar degeneration","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-3-qi-5","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"You are diagnosed with major neurocognitive disorder of cerebrovascular origin and depressive syndrome. Which of the following elements of processing are you starting at this stage?","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Balance of cardiovascular risk factors","justification":""},{"idx":1,"correct":false,"proposition":"Acetylcholine esterase inhibitor","justification":""},{"idx":2,"correct":true,"proposition":"Psychological follow-up","justification":""},{"idx":3,"correct":false,"proposition":"Legal protection","justification":"The patient remains autonomous with an MMS score that does not seem to put her at risk."},{"idx":4,"correct":true,"proposition":"Personalized autonomy allowance","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-3-qi-6","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"The patient is sedentary, weighs 70 kgs for 1.52 m or a body mass index of 30 kg \/ m2. Blood pressure is 133\/65 mmHg, heart rate is 45\/min. Her daughter tells you that the patient always has a slow pulse when she takes her constants at home, between 40 and 50\/min. The systolic pressure index is 1.2. HbA1C 7.9%, albumin 31 g\/l, CRP 2 mg\/L (normal 5), hemoglobin 12 g\/dL. Regarding the cardiovascular risk factors of this patient, what measure(s) are you taking? ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Low-calorie diet","justification":""},{"idx":1,"correct":false,"proposition":"Low carbohydrate diet","justification":""},{"idx":2,"correct":true,"proposition":"High protein diet","justification":""},{"idx":3,"correct":false,"proposition":"Sodium diet","justification":""},{"idx":4,"correct":true,"proposition":"Adapted physical activity","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-3-qi-7","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"Regarding the systolic pressure index (SPI), which proposal(s) is(are) right? ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"It allows the screening of arterial disease obliterans of the lower limbs","justification":""},{"idx":1,"correct":false,"proposition":"Its measurement is contraindicated in case of critical ischemia","justification":""},{"idx":2,"correct":true,"proposition":"It is calculated as the ratio of ankle blood pressure to humeral blood pressure.","justification":""},{"idx":3,"correct":true,"proposition":"An SPI greater than 1.30 reflects incompressible, rigid and calcified arteries","justification":""},{"idx":4,"correct":true,"proposition":"It makes it possible to follow the evolution of arterial disease obliterating the lower limbs","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-3-qi-8","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"The patient also reports three recent falls, while her daughter specifies that she did not fall before. The patient mentions a dizzying sensation during the first fall, fleeting, but evokes above all a clumsiness each time, as when she stumbled into the edge of a sidewalk. ENT explorations carried out in the city are normal. You perform a search for orthostatic hypotension. Choose the right proposal(s) from the following:","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Negative research eliminates orthostatic hypotension","justification":""},{"idx":1,"correct":false,"proposition":"An acceleration of the heart rate > 100\/min evokes dysautonomia","justification":""},{"idx":2,"correct":true,"proposition":"A decrease in systolic blood pressure 20 mmHg at orthostatism confirms the diagnosis","justification":""},{"idx":3,"correct":false,"proposition":"The absence of symptoms at orthostatism rules out the diagnosis","justification":""},{"idx":4,"correct":true,"proposition":"An isolated decrease in diastolic blood pressure of > 1O mmHg at orthostatism confirms the diagnosis","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-3-qi-9","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"You confirm orthostatic hypotension in this patient. Which of the following factors, in the case of this patient, may have contributed to this? ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Non-insulin-dependent diabetes","justification":""},{"idx":1,"correct":false,"proposition":"High blood pressure","justification":""},{"idx":2,"correct":true,"proposition":"Calcium channel blocker","justification":""},{"idx":3,"correct":false,"proposition":"Sedentary lifestyle","justification":""},{"idx":4,"correct":false,"proposition":"Hemoglobin level","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-3-qi-10","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"The systolic pressure index is 1.2.What therapeutic measure(s) in first line do you take regarding this orthostatic hypotension? ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Class 2 venous compression","justification":""},{"idx":1,"correct":false,"proposition":"Addition of midodrine","justification":""},{"idx":2,"correct":false,"proposition":"Addition of fludrocortisone","justification":""},{"idx":3,"correct":false,"proposition":"Discontinuation of antihypertensive therapy","justification":""},{"idx":4,"correct":true,"proposition":"Regular physical activity","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-3-qi-11","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"What abnormality(s) do you notice on this ECG? ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Sinus rhythm","justification":""},{"idx":1,"correct":true,"proposition":"Second degree atrioventricular block","justification":""},{"idx":2,"correct":false,"proposition":"Paroxysmal sinoatrial block","justification":""},{"idx":3,"correct":true,"proposition":"Left axis of QRS","justification":""},{"idx":4,"correct":true,"proposition":"Right branch block","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-3-qi-12","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"In view of the entire file, what anomaly(s) are you looking for on the holter requested by the attending physician? ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Sinus dysfunction","justification":""},{"idx":1,"correct":true,"proposition":"Paroxysmal atrial fibrillation","justification":""},{"idx":2,"correct":false,"proposition":"Paroxysmal ventricular tachycardia","justification":""},{"idx":3,"correct":false,"proposition":"Ischemic heart disease","justification":""},{"idx":4,"correct":true,"proposition":"High-grade atrioventricular block","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-3-qi-13","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"The holter shows sinus dysfunction (high-degree sinoatrial block) and nodal dysfunction (BAV2 Mobitz 2) with long periods of bradycardia between 35 and 40 per minute, without AF. Which treatment(s) do you decide? ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Double chamber pacemaker installation","justification":""},{"idx":1,"correct":false,"proposition":"Discontinuation of calcium channel blocker","justification":"-dipine is not bradycardial (non-cardio-selective)."},{"idx":2,"correct":false,"proposition":"Curative anticoagulant treatment","justification":""},{"idx":3,"correct":false,"proposition":"Amiodarone","justification":""},{"idx":4,"correct":false,"proposition":"Therapeutic abstention and monitoring","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-3-qi-14","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"Finally, tests show a creatinine clearance of 27 mL\/min. You recover a value a year ago at 29 mL \/ min whose vascular and diabetic origin had been retained. What impact does this information have on your current or future treatment? ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Contraindication to angiotensin-converting enzyme inhibitor therapy","justification":""},{"idx":1,"correct":true,"proposition":"Contraindication to bisphosphonate therapy if indicated","justification":"Car DFG30."},{"idx":2,"correct":false,"proposition":"Contraindication to a high protein diet","justification":""},{"idx":3,"correct":false,"proposition":"Contraindication to treatment with denosumab if indicated","justification":""},{"idx":4,"correct":false,"proposition":"Contraindication to pravastatin","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-4-qi-1","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"This patient consumed 1 glass of whisky per day and 75 cl of wine per day. He has been weaned for 3 months following the discovery of cirrhosis. About cirrhosis, what is the exact proposal(s)?","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Has a histological definition","justification":""},{"idx":1,"correct":true,"proposition":"Is a fibrous scar of the hepatic parenchyma","justification":""},{"idx":2,"correct":false,"proposition":"Is an irreversible disease","justification":""},{"idx":3,"correct":true,"proposition":"May be asymptomatic","justification":""},{"idx":4,"correct":true,"proposition":"Can be diagnosed without liver biopsy","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-4-qi-2","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"The clinical examination is unremarkable. He has no sign of portal hypertension, no sign of severe sepsis. The biological balance shows: Na at 135mmol \/ L, K at 3.7mmol \/ L, CRP at 15mg \/ L, creatinine at 80 μmol \/ L, urea at 6.1 mmol \/ L, Hb at 137g \/ L, platelets at 120G \/ L, PNN at 7.45G \/ L, TP at 43%, TCA at 35\/28, AST at 69Ul \/ L, ALT at 33IU \/ L, Alkaline phosphatase at 146U \/ L,  gammaGT at 236 IU\/L. The patient has abundant daily sputum. In front of dyspnea, you realize the arterial blood gases in ambient air: pH at 7.49, PCO2 at 29mmHg, P02 at 75mmHg, HCO3- at 22mmol. What is your interpretation (only one answer)? ","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Compensated metabolic alkalosis","justification":""},{"idx":1,"correct":false,"proposition":"Decompensated metabolic alkalosis","justification":""},{"idx":2,"correct":false,"proposition":"Decompensated mixed alkalosis","justification":""},{"idx":3,"correct":false,"proposition":"Compensated respiratory alkalosis","justification":""},{"idx":4,"correct":true,"proposition":"Decompensated respiratory alkalosis","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-4-qi-3","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"Chest X-ray shows a left basal opacity. You complete by performing a chest scan. What is the real proposal(s)?","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The mark A corresponds to the arch of the aorta","justification":""},{"idx":1,"correct":false,"proposition":"Benchmark B corresponds to the trunk of the pulmonary artery","justification":""},{"idx":2,"correct":false,"proposition":"The C mark corresponds to the left stem bronchus","justification":""},{"idx":3,"correct":false,"proposition":"Coordinate system D corresponds to the esophagus","justification":""},{"idx":4,"correct":false,"proposition":"The mark E corresponds to the inferior vena cava","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-4-qi-4","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"The mediastinal window shows lymphadenopathy. Here is a chest window computed tomography section. What do you observe? (one or more correct answers) ","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Micronodules","justification":""},{"idx":1,"correct":false,"proposition":"Intralobular cross-linking","justification":""},{"idx":2,"correct":false,"proposition":"From the honeycomb","justification":""},{"idx":3,"correct":false,"proposition":"An aspect in << release of balloons>>","justification":""},{"idx":4,"correct":true,"proposition":"A nodule of about 3 cm","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-4-qi-5","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"What diagnostic hypothesis(s) can explain the entire thoracic clinico-radiological picture? ","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Diffuse bronchiolitis","justification":""},{"idx":1,"correct":false,"proposition":"Stage I pulmonary carcinoma","justification":""},{"idx":2,"correct":false,"proposition":"Carcinomatous lymphangitis","justification":""},{"idx":3,"correct":false,"proposition":"Hypersensitivity pneumonitis","justification":""},{"idx":4,"correct":true,"proposition":"Pulmonary tuberculosis","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-4-qi-6","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"You suspect a tuberculosis miliary. How do you make the first-line diagnosis (one or more correct answers)? ","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Examination of sputum addressed in mycobacteriology for acid-alcohol-resistant bacilli (BAAR)","justification":""},{"idx":1,"correct":true,"proposition":"Cytobacteriological examination of urine addressed in mycobacteriology for acid-alcohol-resistant bacilli (RBBA)","justification":""},{"idx":2,"correct":false,"proposition":"Bronchoalveolar lavage addressed in mycobacteriology in search of acid-alcohol-resistant bacilli (BAAR)","justification":"Not in the first intention. It is done if the patient does not spit, the gastric tubing is negative, and the supiscion is diagnosis is strong."},{"idx":3,"correct":false,"proposition":"Lymph node puncture by bronchial endoscopic ultrasound addressed in mycobacteriology in search of acid-alcohol-resistant bacilli (BAAR)","justification":""},{"idx":4,"correct":false,"proposition":"Transthoracic puncture guided by CT scan of the mass addressed in mycobacteriology in search of acid-alcohol-resistant bacilli (BAAR)","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-4-qi-7","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"Sputum analysis shows 10 to 100 BAAR\/field live. You retain the diagnosis of miliary tuberculosis to M. tuberculosis. Which examination(s) should be taken into consideration in your pre-therapeutic assessment? ","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Hepatic test","justification":""},{"idx":1,"correct":true,"proposition":"Creatinine","justification":""},{"idx":2,"correct":true,"proposition":"Ophthalmological examination","justification":""},{"idx":3,"correct":false,"proposition":"Pulmonary function testing","justification":""},{"idx":4,"correct":true,"proposition":"HIV serology","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-4-qi-8","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"What anti-TB treatment(s) will you offer this patient as a first-line treatment? ","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Isoniazid (INH)","justification":""},{"idx":1,"correct":false,"proposition":"Streptomycin","justification":""},{"idx":2,"correct":true,"proposition":"Ethambutol (EMB)","justification":""},{"idx":3,"correct":true,"proposition":"Rifampicin (RMP)","justification":""},{"idx":4,"correct":false,"proposition":"Pyrazinamide (PZA)","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-4-qi-9","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"What is (are) the other measure(s) to put in place in this patient? ","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Inhaled corticosteroid therapy","justification":""},{"idx":1,"correct":true,"proposition":"Request 100% coverage for long-term illness","justification":""},{"idx":2,"correct":true,"proposition":"Respiratory isolation","justification":""},{"idx":3,"correct":true,"proposition":"Anonymous notification to the Regional Health Agency (ARS)","justification":""},{"idx":4,"correct":false,"proposition":"Anonymous notification to the Tuberculosis Centre (CLAT) of the department of the case of domicile","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-4-qi-10","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"You start a combination of isoniazid, rifampicin and ethambutol. After 2 weeks, the patient leaves the hospital. You follow him every month in consultation, but you have doubts about the patient's compliance with the treatment. How do you monitor its observance? (one or more correct answers) ","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Staining of teeth","justification":""},{"idx":1,"correct":true,"proposition":"Urine staining","justification":""},{"idx":2,"correct":false,"proposition":"Determination of uricemia","justification":"The patient is not taking pyrazinamide."},{"idx":3,"correct":false,"proposition":"Determination of transaminases","justification":""},{"idx":4,"correct":false,"proposition":"Color vision","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-4-qi-11","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"The patient wonders about the role of his profession in the occurrence of tuberculosis. You consult the table of occupational diseases 40b of the general scheme. This table indicates that (one or more correct answers):","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Your patient's condition is in the list of conditions that can be recognized as an occupational disease","justification":""},{"idx":1,"correct":false,"proposition":"The period of care indicates that the patient must have been exposed for more than 6 months to be recognized as an occupational disease","justification":""},{"idx":2,"correct":true,"proposition":"Your patient's profession is in the exhaustive list of works","justification":""},{"idx":3,"correct":false,"proposition":"The patient can be directly recognized as an occupational disease","justification":""},{"idx":4,"correct":true,"proposition":"The application for recognition as an occupational disease must go before the regional committee for the recognition of occupational diseases","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-4-qi-12","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"The patient asks you what advantage he can benefit from in case of a possible recognition as an occupational disease? (one or more correct answers) ","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"An impossibility of dismissal","justification":""},{"idx":1,"correct":false,"proposition":"Compensation for damage to possible secondary family cases","justification":""},{"idx":2,"correct":false,"proposition":"Better compensation for sick leave","justification":""},{"idx":3,"correct":true,"proposition":"100% coverage of treatments","justification":""},{"idx":4,"correct":true,"proposition":"A pension based on last salary and disability rate","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-4-qi-13","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"What is your interpretation of these pulmonary function tests (one or more correct answers)? ","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Obstructive ventilatory syndrome","justification":""},{"idx":1,"correct":false,"proposition":"Restrictive ventilatory syndrome","justification":""},{"idx":2,"correct":false,"proposition":"Chest distension"},{"idx":3,"correct":true,"proposition":"Carbon monoxide diffusion disorder","justification":""},{"idx":4,"correct":false,"proposition":"Normal functional explorations","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-4-qi-14","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"The chest computed tomography no longer finds the abnormalities previously described and the pulmonary parenchyma appears normal. On the other hand, there is abnormal dilation of the pulmonary arteries. You suspect pulmonary hypertension associated with portal hypertension. In which group of the International Clinical Classification of Pulmonary Hypertension will you classify this patient? ","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Group 1","justification":""},{"idx":1,"correct":false,"proposition":"Group 2","justification":""},{"idx":2,"correct":false,"proposition":"Group 3","justification":""},{"idx":3,"correct":false,"proposition":"Group 4","justification":""},{"idx":4,"correct":false,"proposition":"Group 5","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-5-qi-1","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"On the wrist x-rays performed in the emergency room, what is(are) the exact proposal(s)?","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"The radial glenoid is anteverted","justification":""},{"idx":1,"correct":true,"proposition":"The radius fracture is extra-articular","justification":""},{"idx":2,"correct":false,"proposition":"The bistyloid line is verticalized","justification":""},{"idx":3,"correct":false,"proposition":"There is an excess length of the radius compared to the ulna","justification":""},{"idx":4,"correct":true,"proposition":"The fracture of the radius has a metaphyseal site","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-5-qi-2","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"On clinical examination, what element(s) do you find if the radius fracture is uncomplicated?","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"A medial bayonet face deformation","justification":""},{"idx":1,"correct":true,"proposition":"A deformation on the back of a fork","justification":""},{"idx":2,"correct":false,"proposition":"A hypoesthesia of the pulp of the first 3 fingers","justification":""},{"idx":3,"correct":false,"proposition":"An elective pain of the anatomical snuffbox","justification":""},{"idx":4,"correct":true,"proposition":"A protrusion of the styloid of the ulna","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-5-qi-3","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"During the initial clinical examination, the patient fails to perform active flexion of the interphalangienoe joint of the thumb. What is the exact proposal(s)?","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"This may be due to compression of the median nerve in the wrist.","justification":""},{"idx":1,"correct":true,"proposition":"This must evoke a cause other than the fracture itself.","justification":""},{"idx":2,"correct":false,"proposition":"This may be due to paralysis of the long abductor of the thumb.","justification":""},{"idx":3,"correct":false,"proposition":"This may be due to paralysis of the opponent of the thumb","justification":""},{"idx":4,"correct":true,"proposition":"This may be due to damage to the tendon of the long flexor of the thumb.","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-5-qi-4","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"Which imaging examination(s) prescribed in first line seem to you relevant for his functional impotence of the lower right limb?","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Computed tomography of the pelvis and right hip","justification":""},{"idx":1,"correct":true,"proposition":"X-ray of the front pelvis","justification":""},{"idx":2,"correct":true,"proposition":"X-ray of the right hip in profile","justification":""},{"idx":3,"correct":false,"proposition":"Bone scintigraphy","justification":""},{"idx":4,"correct":false,"proposition":"Angiocomputed tomography of the pelvis and right lower limb","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-5-qi-5","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"In view of the X-ray of the pelvis attached, what is the exact proposal?","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"This is a type 1 fracture according to Garden's classification","justification":""},{"idx":1,"correct":false,"proposition":"This is a type 2 fracture according to Garden's classification","justification":""},{"idx":2,"correct":false,"proposition":"This is a type 3 fracture according to Garden's classification","justification":""},{"idx":3,"correct":false,"proposition":"This is a type 4 fracture according to Garden's classification","justification":""},{"idx":4,"correct":true,"proposition":"Garden's classification does not apply for this type of fracture","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-5-qi-6","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"In view of the attached radiography of the pelvis, what is (are) the exact proposal(s)?","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"There is a deformation in coxa vara","justification":"The angle between the head and the diaphysis is well reduced."},{"idx":1,"correct":false,"proposition":"There are gaps in << the >> punch of the left iliac wing","justification":""},{"idx":2,"correct":false,"proposition":"This is a sub-capital divide","justification":""},{"idx":3,"correct":true,"proposition":"It is a fracture of the trochanterian massif","justification":""},{"idx":4,"correct":false,"proposition":"There is a loss of congruence of the right coxofemoral joint","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-5-qi-7","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"You explain to the patient that she has a fracture of the proximal femur that requires surgery. The patient is reluctant to have an intervention for fear of possible complications. Which proposal(s) is (are) accurate?","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"In the absence of intervention, fracture consolidation is possible","justification":""},{"idx":1,"correct":true,"proposition":"In the absence of intervention, there is a major risk of death related to complications of decubitus","justification":""},{"idx":2,"correct":true,"proposition":"The intervention is necessary to allow a rapid verticalization of the patient","justification":""},{"idx":3,"correct":true,"proposition":"The increase in the time before the intervention modifies the morbidity and mortality in the aftermath of the intervention","justification":""},{"idx":4,"correct":true,"proposition":"Stabilization surgery can effectively fight pain","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-5-qi-8","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"Regarding anesthesia, what can you say to this patient? (one or more correct answers)","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The choice between general or locoregional anaesthesia has no real influence on postoperative morbidity and mortality","justification":""},{"idx":1,"correct":true,"proposition":"It will be mandatory to place a venous catheter and that the patient remains fasting whether it is a general or locoregional anesthesia","justification":""},{"idx":2,"correct":false,"proposition":"There is no cardiac risk under regional anaesthesia","justification":""},{"idx":3,"correct":false,"proposition":"If the anaesthetist opts for regional anesthesia, the patient is not required to stay in the recovery room","justification":""},{"idx":4,"correct":true,"proposition":"Several analgesics are usually used multimodally to reduce morphine consumption postoperatively.","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-5-qi-9","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"Prior to her fall, the patient was travelling to the home without technical assistance. For the past few months, she had been using a cane for walks and when she went shopping, she used a rollator. What is the exact proposal(s)? ","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Parker's mobility score takes into account walking outside the home","justification":""},{"idx":1,"correct":false,"proposition":"Parker's mobility score is a quality of life score","justification":""},{"idx":2,"correct":true,"proposition":"Parker's mobility score ranges from O to 9","justification":""},{"idx":3,"correct":false,"proposition":"Parker mobility score takes into account the location of the fracture line","justification":""},{"idx":4,"correct":false,"proposition":"After a fracture of the upper extremity of the femur, recovery of the anterior Parker mobility score is the rule","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-5-qi-10","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"Which of the following leads to delay the surgical management of the patient? ","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The patient's refusal to be operated on","justification":""},{"idx":1,"correct":false,"proposition":"Antiplatelet therapy","justification":""},{"idx":2,"correct":false,"proposition":"A cutaneous opening next to the ulnar styloid","justification":""},{"idx":3,"correct":true,"proposition":"Hyperkalemia with ECG changes","justification":""},{"idx":4,"correct":false,"proposition":"A venous ulcer of the right leg","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-5-qi-11","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"In this patient, you opted for proximal femur osteosynthesis using intramedullary material. Following such an intervention, what is (are) the exact proposal(s)? ","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"There is a significant risk of dislocation","justification":""},{"idx":1,"correct":true,"proposition":"The risk of infection at the surgical site is low","justification":""},{"idx":2,"correct":true,"proposition":"The primary complication is the vicious callus.","justification":""},{"idx":3,"correct":false,"proposition":"If after one month, the fracture is not consolidated, it is a delay in consolidation","justification":""},{"idx":4,"correct":true,"proposition":"If after 8 months the fracture is not consolidated, it is pseudarthrosis","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-5-qi-12","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"Days after osteosynthesis, the patient slips on the wet floor on her way to the toilet and falls again. The patient complains of increased pain in the right hip. You take x-rays of the pelvis and right hip. What is the exact proposal(s)? ","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"There is a secondary displacement compared to intraoperative reduction plates","justification":""},{"idx":1,"correct":false,"proposition":"There is a dislocation of the right hip","justification":""},{"idx":2,"correct":false,"proposition":"There is a break in the hardware","justification":""},{"idx":3,"correct":false,"proposition":"There is a high risk of osteonecrosis of the femoral head","justification":""},{"idx":4,"correct":true,"proposition":"There is a decrease in the effectiveness of action of ilio-psoas","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-5-qi-13","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"During her fall, the patient also complains of spinal pain that you locate mainly at the thoracolumbar junction and which is accompanied by more diffuse pain. An MRI is performed. There is no transitional anomaly. In view of this review, what is the exact proposal(s)? ","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"There is a deformation of the vertebral body of T12","justification":""},{"idx":1,"correct":false,"proposition":"This is a sequence in T1","justification":""},{"idx":2,"correct":false,"proposition":"There is an antelisthesis of L4 on L5","justification":""},{"idx":3,"correct":true,"proposition":"The T12 fracture is recent","justification":""},{"idx":4,"correct":true,"proposition":"There are signs of disc degeneration between L 1 and L2","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-5-qi-14","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"The patient is reoperated on the right hip. In the aftermath of the intervention, she presents a state of agitation. Which element(s) of the clinical examination do you think is important in the etiological search for this state of agitation? ","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Performing a digital rectal exam","justification":""},{"idx":1,"correct":true,"proposition":"Abdominal palpation","justification":""},{"idx":2,"correct":true,"proposition":"Examination of cranial pairs","justification":""},{"idx":3,"correct":true,"proposition":"A measurement of capillary blood glucose","justification":""},{"idx":4,"correct":false,"proposition":"Performing the clock test","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-6-qi-1","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"Which of the following is(are) one or more criteria for severity of acute bronchiolitis in this child? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"His premature birth","justification":""},{"idx":1,"correct":false,"proposition":"Intercostal draw","justification":""},{"idx":2,"correct":true,"proposition":"Respiratory rate","justification":""},{"idx":3,"correct":false,"proposition":"High temperature","justification":"The criteria are very specific. Temperature is not one of them."},{"idx":4,"correct":true,"proposition":"His eating difficulties","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-6-qi-2","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"In this child, which is (are) the essential examination(s) ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Multiplex PCR for respiratory viruses","justification":""},{"idx":1,"correct":false,"proposition":"A rapid flu test","justification":""},{"idx":2,"correct":true,"proposition":"A chest X-ray","justification":""},{"idx":3,"correct":false,"proposition":"An arterial blood gas","justification":""},{"idx":4,"correct":false,"proposition":"A cardiac ultrasound","justification":"Careful! The new HAS 2019 recommendation taken up in the R2C colleges of pediatrics make this proposal obsolete."}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-6-qi-3","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"In front of this chest X-ray, what is(are) the exact answer(s)? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Presence of chest distension","justification":""},{"idx":1,"correct":false,"proposition":"Presence of pleural effusion","justification":""},{"idx":2,"correct":true,"proposition":"Presence of pneumomediastinum","justification":""},{"idx":3,"correct":true,"proposition":"Presence of mean lobar alveolar condensation","justification":"Medium lobe because erases the edges of the heart"},{"idx":4,"correct":false,"proposition":"The upper left arc is not visible","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-6-qi-4","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"The child is hospitalized for 4 rounds for the treatment of bronchiolitis complicated by pneumornediastin. It was fed the first two days by nasogastric tube. Infusion was not necessary. His respiratory signs are improving. While he was out, he presents vomiting followed twelve hours later by profuse diarrhea with a temperature of 37.3 ° C.  What is the possible cause(s) of this acute diarrhoea? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Adenovirus infection","justification":""},{"idx":1,"correct":true,"proposition":"Norovirus infection","justification":""},{"idx":2,"correct":true,"proposition":"C.","justification":""},{"idx":3,"correct":false,"proposition":"Enterovirus infection","justification":"He didn't get antibiotics. He is not feverish."},{"idx":3,"correct":false,"proposition":"RSV infection","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-6-qi-5","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"Regarding the episode of acute gastroenteritis of viral origin, which is(are) the exact statement(s)? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"It is an infection preventable by droplet precautions << >>","justification":""},{"idx":1,"correct":true,"proposition":"It is a certain nosocomial infection","justification":""},{"idx":2,"correct":false,"proposition":"The germ responsible for diarrhea is resistant to hydroalcoholic fluids (SHA)","justification":""},{"idx":3,"correct":false,"proposition":"It is necessary to make a declaration to the ARS (Regional Health Agency) of this infection","justification":""},{"idx":4,"correct":true,"proposition":"It is a manu-supported infection","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-6-qi-6","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"Given the severity of the picture, intravenous rehydration is decided. A blood sample is taken at the time of the infusion. The results of this assessment are as follows: natremia 125 mmol \/ L, serum potassium 3.7 mmol \/ l, blood glucose 7.4 mmol \/ L. What is (are) the possible diagnosis(s) in this child? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Cystic fibrosis","justification":""},{"idx":1,"correct":true,"proposition":"Oral rehydration with pure water given by parents","justification":""},{"idx":2,"correct":false,"proposition":"Intravenous rehydration with a solution not rich enough in sodium","justification":""},{"idx":3,"correct":false,"proposition":"Ulcerative-necrotizing enterocolitis","justification":""},{"idx":4,"correct":false,"proposition":"Hemolytic uremic syndrome (HUS)","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-6-qi-7","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"At the end of the infusion, the child makes clonic movements of the 4 limbs for 1 minute. It has no post-critical deficit. Which of the following diagnoses can be considered in this child? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"A complex febrile convulsion","justification":""},{"idx":1,"correct":true,"proposition":"An occasional seizure related to hyponatremia","justification":""},{"idx":2,"correct":false,"proposition":"West syndrome-type epilepsy","justification":""},{"idx":3,"correct":true,"proposition":"Cerebral venous thrombosis","justification":""},{"idx":4,"correct":false,"proposition":"Streptococcal B meningitis","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-6-qi-8","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"After a few days, his clinical condition has improved and you prepare the discharge, he weighs 6000g and by taking the health record you find that he has not been followed since his arrival in France and that no vaccination has been carried out. You worry about his psychomotor development. What are the expected acquisitions for his age? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Stacks two cubes","justification":"1 year"},{"idx":1,"correct":false,"proposition":"Repeats one syllable","justification":"6 months"},{"idx":2,"correct":false,"proposition":"Picks up objects with thumb-index clip","justification":"9 months"},{"idx":3,"correct":true,"proposition":"Play with his hands L","justification":""},{"idx":4,"correct":true,"proposition":"Laughs out loud","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-6-qi-9","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"Given the vaccine delay and its age, which of the following vaccines, is the one to be prioritized? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Influenza","justification":""},{"idx":1,"correct":true,"proposition":"Pneumococcus","justification":""},{"idx":2,"correct":true,"proposition":"Haemophilius","justification":""},{"idx":3,"correct":true,"proposition":"Meningococcal B","justification":""},{"idx":4,"correct":true,"proposition":"Measles","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-6-qi-10","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"Before the outing, which of the following dietary tips do you give to parents? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Use sterilized baby bottles","justification":""},{"idx":1,"correct":true,"proposition":"Bottles can be prepared with tap water","justification":""},{"idx":2,"correct":false,"proposition":"In case of family history of allergy, the introduction of peanut should be postponed","justification":""},{"idx":3,"correct":false,"proposition":"Cow's milk can replace infant milk from the age of 1 year","justification":""},{"idx":4,"correct":false,"proposition":"It will be necessary to give 5 fruits and vegetables per day 1 month after the beginning of diversification","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-6-qi-11","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"You see him again 2 months later for a new episode of respiratory discomfort. Parents tell you he's been cluttered and coughing since his last episode. Its weight is 6,100 g. What is (are) the possible diagnosis(s) given the history of this child? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Infant asthma","justification":""},{"idx":1,"correct":true,"proposition":"Cystic fibrosis","justification":""},{"idx":2,"correct":false,"proposition":"Coarctation of the aorta","justification":""},{"idx":3,"correct":true,"proposition":"Immunodeficiency","justification":""},{"idx":4,"correct":false,"proposition":"Eosinophilic esophagitis","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-6-qi-12","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"You suspect an immune deficiency. If confirmed, what vaccine(s) would be contraindicated in this child? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Injectable flu","justification":""},{"idx":1,"correct":true,"proposition":"Chickenpox","justification":""},{"idx":2,"correct":false,"proposition":"Pneumococcus","justification":""},{"idx":3,"correct":false,"proposition":"Meningococcal C","justification":""},{"idx":4,"correct":false,"proposition":"Hepatitis B","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-6-qi-13","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"No newborn screening was offered to this child. For children born in French maternity wards, newborn screening for cystic fibrosis: ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Requires signed parental consent for potential genetic research","justification":""},{"idx":1,"correct":false,"proposition":"Is proposed on the first day of life in case of delay in the emission of meconium","justification":""},{"idx":2,"correct":true,"proposition":"Is proposed on the third day of life","justification":""},{"idx":3,"correct":false,"proposition":"Consists of the analysis of the CFTR gene when the immunoreactive trypsin assay is below the threshold of positivity","justification":""},{"idx":4,"correct":true,"proposition":"Is sensitive but not very specific","justification":"There are many false positives but few false negatives: this is what we expect from a screening test (we do not want to miss a disease)."}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-6-qi-14","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"This child has a homozygous delta-F508 mutation. What support do you implement? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Daily chest physiotherapy sessions","justification":""},{"idx":1,"correct":false,"proposition":"Normal power supply","justification":""},{"idx":2,"correct":false,"proposition":"Interruption of breastfeeding","justification":""},{"idx":3,"correct":true,"proposition":"Oral supplementation of fat-soluble vitamins","justification":""},{"idx":4,"correct":true,"proposition":"Standard vaccination schedule","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-8-qi-1","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"The examination of the perianal region finds the following externalization at the pushing efforts.  Which of the following is correct? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The radial appearance of the folds is in favor of hemorrhoidal prolapse","justification":""},{"idx":1,"correct":false,"proposition":"The appearance of the lesion is in favor of cancer","justification":""},{"idx":2,"correct":false,"proposition":"The existence of haemorrhages on contact with or at the time of exemptions is in favour of cancerous degeneration.","justification":""},{"idx":3,"correct":true,"proposition":"The painless nature of the swelling is not in favor of hemorrhoidal thrombosis","justification":""},{"idx":4,"correct":false,"proposition":"This is a total externalized prolapse of the rectum","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-8-qi-2","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"You mention hemorrhoidal prolapse. Regarding your therapeutic care, what is (are) the exact proposal(s)?","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Regularization of transit is necessary to limit hemorrhoidal manifestations","justification":""},{"idx":1,"correct":false,"proposition":"This patient must be operated urgently, he risks thrombosis quickly","justification":""},{"idx":2,"correct":true,"proposition":"The regularization of transit and hygiene-dietary rules may be sufficient to relieve the patient","justification":""},{"idx":3,"correct":true,"proposition":"If he remains embarrassed after medical care, surgery may be considered","justification":""},{"idx":4,"correct":false,"proposition":"Hemorrhoids are a risk factor for cancer","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-8-qi-3","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"Regarding the care and follow-up of the patient, what is (are) the exact proposal(s)? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Once the hygiene-dietary rules are established, if the patient is relieved, there are no other examinations to perform","justification":""},{"idx":1,"correct":false,"proposition":"Surgery should be planned as soon as possible, there is no need to continue pre-operative explorations","justification":""},{"idx":2,"correct":true,"proposition":"The presence of rectal bleeding requires a colonoscopy","justification":""},{"idx":3,"correct":false,"proposition":"To authenticate bleeding, the patient may be offered a stool blood test.","justification":""},{"idx":4,"correct":false,"proposition":"In this context of symptomatic hemorrhoidal disease, colonoscopy can only be considered once the hemorrhoidal problem has been resolved.","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-8-qi-4","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"A colonoscopy under general anesthesia is performed. It highlights at the level of the sigmoid colon the following image that is not passable. Which of the following proposals concerning iconography is (are) accurate? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"It is an irregular and ulcerated lesion suggestive of a malignant tumor","justification":""},{"idx":1,"correct":false,"proposition":"It is an inflammatory colonic diverticulum","justification":""},{"idx":2,"correct":false,"proposition":"The mucosa around the lesion is inflammatory and suggestive of chronic inflammatory bowel disease","justification":""},{"idx":3,"correct":true,"proposition":"This lesion may explain the patient's increased constipation in recent months.","justification":""},{"idx":4,"correct":false,"proposition":"Endoscopic removal of the lesion is necessary to perform a total colonoscopy","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-8-qi-5","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"The biopsy confirms that it is a well-differentiated lieberkhunian adenocarcinoma. Which of the following proposals concerning the extension and pre-therapeutic assessment is (are) accurate? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The thoraco-abdomino-pelvic CT scan is the reference examination for the extension assessment of this colon cancer","justification":""},{"idx":1,"correct":false,"proposition":"The PET scan must be performed to detect locations not seen on the scanner","justification":""},{"idx":2,"correct":false,"proposition":"The patient cannot be operated on if the colonoscopy is not complete","justification":""},{"idx":3,"correct":false,"proposition":"The determination of CA 125 and CA 19.9 markers is indicated","justification":""},{"idx":4,"correct":true,"proposition":"It is necessary to schedule a new pre-operative anesthesia consultation","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-8-qi-6","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"There are no metastases. Which of the following proposals for patient care is correct? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"The patient's file must imperatively be presented in a multidisciplinary consultation meeting (RCP) before any treatment","justification":""},{"idx":1,"correct":true,"proposition":"Surgery is the gold standard treatment for non-metastatic colon cancer and the only curative option","justification":""},{"idx":2,"correct":false,"proposition":"Preoperative radiotherapy may be offered to improve the chances of local control of this advanced cancer","justification":""},{"idx":3,"correct":true,"proposition":"Chemotherapy may be indicated post-operative depending on the results of the histopathological examination of the operating room","justification":""},{"idx":4,"correct":false,"proposition":"Intraperitoneal intraperitoneal chemohyperthermia can be performed to prevent loco-regional recurrence","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-8-qi-7","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"You are planning a colectomy. Which of the proposals for the rules of cancer surgery is correct? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"A colectomy with tumour safety margins of at least 5 cm is required","justification":""},{"idx":1,"correct":true,"proposition":"A lymph node dissection requires at least 12 lymph nodes for proper assessment of lymph node status","justification":""},{"idx":2,"correct":true,"proposition":"A colectomy with restoration of digestive continuity and without stoma is the rule in this situation apart from the emergency or an intraoperative abnormality","justification":""},{"idx":3,"correct":false,"proposition":"A stoma must be performed because the tumor has evolved and chemotherapy must be started quickly","justification":""},{"idx":4,"correct":true,"proposition":"In case of discovery of peritoneal carcinomatosis during the intervention, it is allowed to postpone the colectomy and to discuss the patient's file again in multidisciplinary consultation meeting","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-8-qi-8","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"The patient is operated in good conditions, with a restoration of continuity at the same time operative. The report of the histopathological examination concludes that circumlateral adenocarcinoma invades the sub-serosa. There is an invaded lymph node out of the 13 examined. There are vascular embols and perinervous sheaths. There is instability of micro-satellites. Which of the proposals concerning the stage of the disease and its prognosis is (are) accurate? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"It is a pT3N1 tumour","justification":""},{"idx":1,"correct":true,"proposition":"It is stage III colon cancer","justification":""},{"idx":2,"correct":false,"proposition":"The prognosis for overall survival at 5 years is 95%","justification":""},{"idx":3,"correct":true,"proposition":"The presence of vascular emboli is a factor of poor prognosis","justification":""},{"idx":4,"correct":false,"proposition":"Peri-nervous sheathing has no impact on prognosis","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-8-qi-9","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"The postoperative period is marked by the appearance of a fever at 38.5 ° C on the 5th day.   Which of the following is correct?","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"It is necessary to evoke a complication type of anastomotic fistula","justification":""},{"idx":1,"correct":true,"proposition":"A complete blood count is indicated","justification":""},{"idx":2,"correct":true,"proposition":"A cytobacteriological examination of urine is indicated in this patient who has undergone urinary catheterization for his procedure","justification":""},{"idx":3,"correct":false,"proposition":"A determination of D-dimer must be carried out","justification":""},{"idx":4,"correct":true,"proposition":"Palpation of the abdominal scar is essential","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-8-qi-10","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"A wall abscess was removed. The sequels are ultimately simple. The patient leaves the ward on Day 7. Regarding the continuation of the care during the first year, which proposal(s) is(are) accurate? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"A colonoscopy should be performed within 6 months as the initial examination was not complete","justification":""},{"idx":1,"correct":true,"proposition":"Given lymph node invasion, adjuvant chemotherapy is indicated","justification":""},{"idx":2,"correct":false,"proposition":"Given the importance of parietal (subserosa) involvement, postoperative radiotherapy should be offered","justification":""},{"idx":3,"correct":true,"proposition":"As part of the patient's management, his colon cancer enters the list of conditions eligible for 100% coverage","justification":""},{"idx":4,"correct":false,"proposition":"Clinical and ultrasound monitoring should be semi-annually","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-8-qi-11","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"What is the element of anamnesis that makes you propose to the patient an onco-genetic consultation? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Age","justification":""},{"idx":1,"correct":false,"proposition":"The stenosing character of the tumor","justification":""},{"idx":2,"correct":false,"proposition":"Localization in the sigmoid colon","justification":""},{"idx":3,"correct":false,"proposition":"The presence of vascular emboli on histological examination","justification":""},{"idx":4,"correct":true,"proposition":"The instability of micro-satellites","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-8-qi-12","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"Which of the following cancers is (are) on the narrow spectrum of Lynch syndrome? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Cancer of the urinary excretory tract","justification":"Two mnemonics: GOBES and VICE (see the mnemo means tab)"},{"idx":1,"correct":false,"proposition":"Breast cancer","justification":""},{"idx":2,"correct":true,"proposition":"Endometrial cancer","justification":""},{"idx":3,"correct":false,"proposition":"Thyroid cancer","justification":""},{"idx":4,"correct":true,"proposition":"Small intestine cancer","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-8-qi-13","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"Finally the patient receives adjuvant chemotherapy that he tolerates well. He wishes to resume his professional activity within a month of the end of his chemotherapy. What can you offer him as a doctor? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Encourage them to file an application for recognition as a disabled worker (RQTH)","justification":""},{"idx":1,"correct":false,"proposition":"Write him a certificate of aptitude for the resumption of his professional activity","justification":""},{"idx":2,"correct":true,"proposition":"Send it now to the occupational physician of his company for a pre-resumption visit","justification":""},{"idx":3,"correct":true,"proposition":"Prescribe part-time for therapeutic reasons","justification":""},{"idx":4,"correct":false,"proposition":"Submit an application for an adult disabled allowance (AAH)","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-8-qi-14","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"A year later, the surveillance scanner shows the following image. Regarding this iconography, which is (are) the exact proposal(s)? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"It is a CT scan injected at arterial time","justification":""},{"idx":1,"correct":true,"proposition":"We individualize on this picture the spleen","justification":""},{"idx":2,"correct":true,"proposition":"A hypodense image compatible with liver metastasis is found","justification":""},{"idx":3,"correct":true,"proposition":"This lesion is located in the left liver","justification":""},{"idx":4,"correct":true,"proposition":"The stomach is visible in this picture","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-8-qi-15","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"This is actually a single liver metastasis of his colorectal cancer. Which of the following proposals for the management of this patient is correct? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"His file must be represented in a multidisciplinary consultation meeting (RCP)","justification":""},{"idx":1,"correct":true,"proposition":"Excision surgery can treat this patient curatively","justification":""},{"idx":2,"correct":true,"proposition":"A preoperative PET scan may be indicated to ensure the absence of further distant metastases","justification":""},{"idx":3,"correct":true,"proposition":" Chemotherapy may be offered to assess the tumor's response to treatment","justification":""},{"idx":4,"correct":false,"proposition":"In this patient already operated on the colon, an intervention on the liver is no longer possible","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-9-qi-1","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"Regarding the facial nerve, which proposals are accurate? (one or more possible answers) ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":" It has a vegetative action","justification":""},{"idx":1,"correct":false,"proposition":"Its sensory ganglion is the trigeminal ganglion","justification":""},{"idx":1,"correct":false,"proposition":"His elbow separates his first portion from his second","justification":"It separates the second portion from the third"},{"idx":1,"correct":true,"proposition":"It innervates the stirrup muscle","justification":""},{"idx":1,"correct":true,"proposition":"It includes an intrapetrous position","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-9-qi-2","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"During peripheral facial paralysis: ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The motor deficit is homogeneous affecting both the upper and lower territory","justification":""},{"idx":1,"correct":false,"proposition":"There is an automatic-voluntary dissociation","justification":""},{"idx":2,"correct":true,"proposition":"We can observe a sign of Charles-Bell","justification":""},{"idx":3,"correct":true,"proposition":"We can observe a sign of the eyelashes of Souques","justification":""},{"idx":4,"correct":false,"proposition":"Facial features are deflected to the paralyzed side","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-9-qi-3","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"What are the additional examinations that you will carry out initially? ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Bilateral otoscopy","justification":""},{"idx":1,"correct":true,"proposition":"Examination of other cranial pairs","justification":""},{"idx":2,"correct":true,"proposition":"Tonal audiometry","justification":""},{"idx":3,"correct":true,"proposition":"Search for stapedial reflexes","justification":""},{"idx":4,"correct":true,"proposition":"Speech audiometry","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-9-qi-4","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"What diagnosis do you evoke in front of this aspect? ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Seromucosal otitis","justification":""},{"idx":1,"correct":false,"proposition":"Fibroadhesive otitis","justification":""},{"idx":2,"correct":false,"proposition":"Earwax cap","justification":""},{"idx":3,"correct":true,"proposition":"Cholesteatoma","justification":""},{"idx":4,"correct":false,"proposition":"Retraction bag","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-9-qi-5","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"You diagnose a cholesteatoma. You perform a tonal audiometry of which here is the result. These curves are characteristic of: ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Right-hand transmission hearing loss","justification":""},{"idx":1,"correct":false,"proposition":"Left sensorineural hearing loss","justification":""},{"idx":2,"correct":false,"proposition":"Left mixed deafness","justification":""},{"idx":3,"correct":true,"proposition":"Left transmission hearing loss","justification":""},{"idx":4,"correct":false,"proposition":"Righteous sensorineural hearing loss","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-9-qi-6","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"You diagnose left-handed conductive hearing loss. You perform an acoumetry. What is the exact proposal(s): ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"In the Weber test, the sound is lateralized on the left side.","justification":""},{"idx":1,"correct":false,"proposition":"Weber's test will be said to be positive","justification":"Weber is neither positive nor negative: he is either lateralized or non-lateralized."},{"idx":2,"correct":true,"proposition":"Rinne's test will be said to be negative","justification":""},{"idx":3,"correct":true,"proposition":"In the Rinne test, bone conduction will be better than air conduction","justification":""},{"idx":4,"correct":false,"proposition":"Stageian reflexes will be present","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-9-qi-7","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"Regarding the innervation of the face and neck:","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"A section of the right hypoglossal nerve will cause during protraction a deviation of the tongue to the left","justification":""},{"idx":1,"correct":false,"proposition":"The levator muscle of the upper eyelid is innervated by the trochlear nerve","justification":""},{"idx":2,"correct":false,"proposition":"A section of the right vagus nerve at the mediastinal level will lead to paralysis of the right hemilarynx","justification":""},{"idx":3,"correct":true,"proposition":"A section of the left cervical sympathetic trunk will lead to Claude Bernard-Homer syndrome","justification":""},{"idx":4,"correct":true,"proposition":"The lateral rectus muscle is innervated by the abducens nerve","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-9-qi-8","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"The clinical examination of this patient shows that when the eyes are closed, his left eye does not close completely and that the deviation of the mouth is well obfecled at rest. You propose as early management:","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Facial electrotherapy","justification":""},{"idx":1,"correct":false,"proposition":"Oral amoxicillin","justification":""},{"idx":2,"correct":true,"proposition":"Eye care","justification":""},{"idx":3,"correct":false,"proposition":"Antiviral treatment with valaciclovir","justification":""},{"idx":4,"correct":true,"proposition":"Facial physiotherapy","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-9-qi-9","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"You carry out as an additional examination (an expected answer): ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Schüller incidence radiography","justification":""},{"idx":1,"correct":true,"proposition":"Scanning of the two rocks without injection of contrast medium","justification":""},{"idx":2,"correct":false,"proposition":"Bone scintigraphy","justification":""},{"idx":3,"correct":false,"proposition":"Early auditory evoked potentials","justification":""},{"idx":4,"correct":false,"proposition":"Microbiological","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-9-qi-10","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"You perform a scan of both rocks without injection. On this scanner section of the left rock: ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Arrow 1 designates the vestibule","justification":""},{"idx":1,"correct":true,"proposition":"Arrow 1 points to the cochlea","justification":""},{"idx":2,"correct":true,"proposition":"2 refers to the internal auditory canal","justification":""},{"idx":3,"correct":false,"proposition":"2 refers to the eardrum box","justification":""},{"idx":4,"correct":false,"proposition":"3 refers to the internal carotid artery","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-9-qi-11","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"You propose as support for this chollessteatoma (an expected response): ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Treatment with amoxicillin-clavulanic acid for fifteen days","justification":""},{"idx":1,"correct":false,"proposition":"An instillation of ofloxacin in ear drops, one dose twice daily for one month","justification":""},{"idx":2,"correct":false,"proposition":"A 6-month consultation for a new otoscopy","justification":""},{"idx":3,"correct":true,"proposition":"Surgical treatment","justification":""},{"idx":4,"correct":false,"proposition":"Iterative aspirations under a microscope","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-9-qi-12","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"You operated on this patient by performing a first time of tympanoplasty. You then discuss with him the continuation of his care: ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The patient is at risk of residual cholesteatoma","justification":""},{"idx":1,"correct":true,"proposition":"Monitoring will include regular audiogram","justification":""},{"idx":2,"correct":true,"proposition":"The patient is at risk of recurrent cholesteatoma","justification":""},{"idx":3,"correct":true,"proposition":"Monitoring will include regular imaging","justification":""},{"idx":4,"correct":true,"proposition":"Monitoring will include regular otoscopy","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-9-qi-13","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"The patient does not return to the various follow-up consultations you have scheduled. Three years after the surgery, he consults you again urgently for a large vertigo of sudden beginning, appeared since the day before, accompanied by nausea and vomiting. You are diagnosed with left harmonious vestibular syndrome. You will find at the clinical examination: ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"A right horizontal-rotational nystagmus","justification":""},{"idx":1,"correct":true,"proposition":"During nystagmus, a slow deviation of the eyes to the left","justification":""},{"idx":2,"correct":false,"proposition":"A blind walk deviated to the right","justification":""},{"idx":3,"correct":true,"proposition":"At the maneuver of the outstretched arms, a deviation of the index fingers to the left","justification":""},{"idx":4,"correct":false,"proposition":"Nystagmus persists with eye fixation","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-9-qi-14","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"On otoscopy, you visualize a recurrence of cholesteatoma. Clinical examination shows no involvement of the other cranial pairs. The audiogram shows bone conduction similar to that existing post-operatively. The most likely diagnosis is ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Left vestibular neuritis","justification":""},{"idx":1,"correct":false,"proposition":"Right Wallenberg syndrome","justification":""},{"idx":2,"correct":false,"proposition":"Thrombosis of the left internal auditory artery","justification":""},{"idx":3,"correct":true,"proposition":"Lysis of the left lateral semicircular canal","justification":""},{"idx":4,"correct":false,"proposition":"Spontaneous fracture of the left rock","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-9-qi-15","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"You suspect lysis of the left lateral semicircular canal. You prescribe as additional examinations ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Standard X-ray incidence << rock in orbit >>","justification":""},{"idx":1,"correct":true,"proposition":"Videonystagmography","justification":""},{"idx":2,"correct":true,"proposition":"Left rock scanner without injection","justification":""},{"idx":3,"correct":false,"proposition":"Microbiological","justification":""},{"idx":4,"correct":false,"proposition":"Electromyogram of the face","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-10-qi-1","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"You want to specify the abnormalities found on the blood count. What additional examinations are you requesting? (one or more possible answers) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Determination of vitamin B9","justification":"Anemia is not microcytic"},{"idx":1,"correct":false,"proposition":"TSH test","justification":"Anemia is not normocytic"},{"idx":2,"correct":false,"proposition":"Determination of vitamin B12","justification":"Anemia is not microcytic"},{"idx":3,"correct":true,"proposition":"Determination of ferritinemia","justification":""},{"idx":4,"correct":true,"proposition":"CRP testing","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-10-qi-2","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"What can be the reasons for the hyperplatektosis? (one or more possible answers) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Vitamin deficiency","justification":""},{"idx":1,"correct":true,"proposition":"Iron deficiency","justification":""},{"idx":2,"correct":true,"proposition":"Inflammatory syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Beginning myeloproliferative syndrome","justification":""},{"idx":4,"correct":false,"proposition":"Hemolysis","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-10-qi-3","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"You examine the patient. He has left axillary lymphadenopathy. It has no hepatosplenomêgalie. Blood pressure is at 130\/70. The temperature is 37.1°C at the time of the examination. It has very pale skin and you notice a slight thoracic collateral circulalion. You suspect superior cava syndrome. What signs will you look for in favor of this diagnosis? (one or more possible answers) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Shortness of breath when lying down","justification":""},{"idx":1,"correct":false,"proposition":"Stellar angiomas","justification":"This is a sign of hepatocellular insufficiency."},{"idx":2,"correct":true,"proposition":"Jugular turgor","justification":""},{"idx":3,"correct":true,"proposition":"An edema filling the supraclavicular hollows","justification":""},{"idx":4,"correct":false,"proposition":"Edema of the lower limbs","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-10-qi-4","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"He actually does not tolerate the lying position well and sleeps with 2 pillows. Suspecting lymphoma pathology, you refer the patient for hospitalization in hematology. A PET scan is performed quickly. About this review, which propositions are true? (one or more possible answers) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"The marker used is iron-based","justification":"It is glucose-based"},{"idx":1,"correct":true,"proposition":"This is an examination indicated in the initial assessment of aggressive lymphomas","justification":""},{"idx":2,"correct":true,"proposition":"Tumor metabolism is evaluated by the SUV (Standard Uptake Value)","justification":""},{"idx":3,"correct":true,"proposition":"The patient must be fasting","justification":""},{"idx":4,"correct":false,"proposition":"The patient should be infused with glucose serum","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-10-qi-5","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"What is your interpretation? (one or more possible answers) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"There is supra- and subdiaphragmatic lymph node involvement","justification":""},{"idx":1,"correct":false,"proposition":"There is myocardial involvement","justification":""},{"idx":2,"correct":true,"proposition":"It is compatible with an Ann Arbor Stage II","justification":""},{"idx":3,"correct":false,"proposition":"There are many artifacts that hinder interpretation","justification":""},{"idx":4,"correct":false,"proposition":"There is probable damage to the urinary tract","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-10-qi-6","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"The PET scan shows hypermetabolic axillary and mediastinal lymphadenopathy (SUV> 10). What exploration modalities do you choose in this context? (one or more possible answers)","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":" Biopsy of axillary lymphadenopathy","justification":""},{"idx":1,"correct":false,"proposition":"Cytopuncture of axillary lymphadenopathy","justification":""},{"idx":2,"correct":false,"proposition":"Axillary dissection with extemporaneous examination","justification":""},{"idx":3,"correct":false,"proposition":"Immediate fixing of the levy","justification":""},{"idx":4,"correct":false,"proposition":"Mediastinoscopy and mediastinal mass sampling","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-10-qi-7","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"You perform a biopsy of an axillary lymph node. The histological report comes back to you: large cells with destroyed architecture, tumor cells expressing CD20. What is the most likely histological diagnosis? (only one answer expected) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Hodgkin's disease","justification":""},{"idx":1,"correct":true,"proposition":"Diffuse large cell non-Hodgkin B-cell lymphoma","justification":""},{"idx":2,"correct":false,"proposition":"T-cell lymphoma","justification":""},{"idx":3,"correct":false,"proposition":"Follicular lymphoma","justification":""},{"idx":4,"correct":false,"proposition":"Sarcoidosis","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-10-qi-8","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"The diagnosis of diffuse large cell B-cell lymphoma is retained. You perform an osteomedullary biopsy and lumbar puncture which are normal. You want to calculate the usual prognostic score (IPI for international prognostic index) in this patient. What do you need? (one or more possible answers) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Sex","justification":""},{"idx":1,"correct":true,"proposition":"Age","justification":""},{"idx":2,"correct":true,"proposition":"Ann Arbor Clinical Stage","justification":""},{"idx":3,"correct":false,"proposition":"Beta2 microglobulin","justification":""},{"idx":4,"correct":true,"proposition":"LDH","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-10-qi-9","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"What do you offer the patient before starting treatment? (one or more possible answers) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Hepatitis B and C serologies","justification":""},{"idx":1,"correct":false,"proposition":"Brain MRI","justification":""},{"idx":2,"correct":true,"proposition":"Cardiac ultrasound with ejection fraction measurement","justification":""},{"idx":3,"correct":false,"proposition":"HLA typing","justification":""},{"idx":4,"correct":true,"proposition":"Sperm cryopreservation at CECOS","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-10-qi-10","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"You are starting immunochemotherapy such as rituximab, doxorubicin, vindesine, cyclophosphamide, bleomycin and prednisone. What are the classic side effects of doxorubicin (anthracycline): (one or more possible responses)","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Cardiomyopathy","justification":""},{"idx":1,"correct":true,"proposition":"Extensive skin necrosis in case of extravasation","justification":""},{"idx":2,"correct":false,"proposition":"Pulmonary fibrosis","justification":""},{"idx":3,"correct":false,"proposition":"Dysthyroidism","justification":""},{"idx":4,"correct":true,"proposition":"Alopecia","justification":"Non-alopecic chemotherapies to know for NEC are platinum salts, 5-FU and methotrexate."}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-10-qi-11","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"Rituximab: (one or more possible answers) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Is a mouse monoclonal antibody","justification":"xi = chimerical"},{"idx":1,"correct":false,"proposition":"Is an antibody recognizing CD34 surface antigen","justification":""},{"idx":2,"correct":true,"proposition":"May cause viral hepatitis reactivations","justification":""},{"idx":3,"correct":true,"proposition":"May cause cytokine release syndrome on first infusion","justification":""},{"idx":4,"correct":true,"proposition":"Causes B-cell","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-10-qi-12","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"At 10 days of chemotherapy, the patient who is at home, calls you because he is feverish with several temperature peaks at 39 ° C and chills. The blood count carried out the day before shows Hemoglobin 91 g \/ dL, Leukocytes 1.8 G \/ L, neutrophils 0.4 G \/ L, Lymphocytes 1.2 GIL, Monocytes 0.2 G \/ L, Platelets 50 G \/ L. What are the proposals that apply to the blood count? (one or more correct answers) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Pancytopenia","justification":""},{"idx":1,"correct":true,"proposition":"Neutropenia","justification":""},{"idx":2,"correct":true,"proposition":"Lymphopenia","justification":""},{"idx":3,"correct":false,"proposition":"Monocytosis","justification":""},{"idx":4,"correct":true,"proposition":"Thrombocytopenia","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-10-qi-13","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"What attitude do you adopt? ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"You prescribe antibiotic therapy with amoxicillin","justification":""},{"idx":1,"correct":false,"proposition":"You resume corticosteroid therapy","justification":""},{"idx":2,"correct":false,"proposition":"You make him do a chest x-ray in town in emergency","justification":""},{"idx":3,"correct":true,"proposition":"You hospitalize him urgently","justification":""},{"idx":4,"correct":false,"proposition":"You ask him to contact you again after 12 hours of antibiotic treatment","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-10-qi-14","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"When he arrives in the hematology department, what examinations must be carried out urgently? (one or more possible answers) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Blood","justification":""},{"idx":0,"correct":true,"proposition":"ECBU","justification":""},{"idx":0,"correct":false,"proposition":"Myelogram","justification":""},{"idx":0,"correct":false,"proposition":"Microbiological","justification":""},{"idx":0,"correct":false,"proposition":"LDH","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-10-qi-15","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"After taking blood cultures and an ECBU, what therapeutic attitude do you adopt? (one or more possible answers) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Protective Custody","justification":""},{"idx":1,"correct":false,"proposition":"Antibiotic therapy started after blood culture results","justification":""},{"idx":2,"correct":false,"proposition":"Intravenous antifungal","justification":""},{"idx":3,"correct":false,"proposition":"Corticosteroid therapy","justification":""},{"idx":4,"correct":false,"proposition":"Transfusion of red blood cells","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-11-qi-1","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"What late complication(s) may result from contusive eye trauma? Decreased mydriasis of the photomotor reflex","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Retinal detachment","justification":""},{"idx":1,"correct":false,"proposition":"Retinal edema","justification":""},{"idx":2,"correct":true,"proposition":"Ocular hypertonia","justification":""},{"idx":3,"correct":true,"proposition":"A cataract","justification":""},{"idx":4,"correct":true,"proposition":"Mydriasis with decreased photomotor reflex","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-11-qi-2","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"Which symptom(s) would be suggestive of a cataract?","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Photophobia","justification":""},{"idx":1,"correct":true,"proposition":"A monocular diplopia","justification":""},{"idx":2,"correct":false,"proposition":"Metamorphopsies","justification":""},{"idx":3,"correct":false,"proposition":"Phosphenes","justification":""},{"idx":4,"correct":false,"proposition":"Visual field amputation","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-11-qi-3","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"Which symptom(s) would be suggestive of retinal detachment? ","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Photophobia","justification":""},{"idx":1,"correct":false,"proposition":"A monocular diplopia","justification":""},{"idx":2,"correct":false,"proposition":"Lagophthalmos","justification":""},{"idx":3,"correct":true,"proposition":"Phosphenes","justification":""},{"idx":4,"correct":true,"proposition":"Visual field amputation","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-11-qi-4","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"Your clinical examination regains a visual acuity measured at 10\/10 P2 with a correction in glasses of -1 (-0.50 to 85 °) in the right eye, and << see the hand move >> with -3 (-0.75 to 75 °) on the left eye. What refractive disorder(s) is present in this patient ","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Low myopia"},{"idx":1,"correct":false,"proposition":"Strong myopia"},{"idx":2,"correct":false,"proposition":"Hyperopia"},{"idx":3,"correct":false,"proposition":"Unepresbyopia"},{"idx":4,"correct":true,"proposition":"Astigmatism"}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-11-qi-5","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"Intraocular pressure is measured at 18 mm Hg in the right eye and 20 mm Hg in the left eye. The examination of the anterior segment of the right eye is without departure. Examination of the anterior segment of the left eye finds a deep anterior chamber and a total white cataract. The examination of the eye food is unremarkable on the right side and not visible on the left side. What other abnormality(s) of traumatic origin could you find in the anterior segment of the left eye? ","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"A miosis","justification":""},{"idx":1,"correct":true,"proposition":"Subluxation of the lens","justification":""},{"idx":2,"correct":true,"proposition":"Iridodialysis","justification":""},{"idx":3,"correct":true,"proposition":"A rupture of the iris sphincter","justification":""},{"idx":4,"correct":false,"proposition":"Central corneal opacification","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-11-qi-6","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"What additional examination(s) are you requesting to clarify the condition of the eye structures of the left eye? ","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"An examination of the visual field","justification":""},{"idx":1,"correct":false,"proposition":"Optical coherence tomography (macular OCT).","justification":""},{"idx":2,"correct":true,"proposition":"An ocular ultrasound in mode B","justification":""},{"idx":3,"correct":false,"proposition":"Keratometry","justification":""},{"idx":4,"correct":false,"proposition":"An orbital scanner","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-11-qi-7","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"What examination(s) are needed before cataract surgery? ","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Pachymetry","justification":""},{"idx":1,"correct":true,"proposition":"Keratometry","justification":""},{"idx":2,"correct":false,"proposition":"A corneal topography","justification":""},{"idx":3,"correct":true,"proposition":"A measurement of the axial length of the eye","justification":""},{"idx":4,"correct":false,"proposition":"A kinetic Goldmann visual field","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-11-qi-8","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"The ultrasound is without particularity to the left eye. You offer the patient cataract surgery on his left eye. What explanation(s) do you give to the patient? ","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Surgery is performed during a traditional 2-day hospitalization","justification":"Outpatient, without hospitalization"},{"idx":1,"correct":true,"proposition":"Anesthesia is most often local or locoregional","justification":""},{"idx":2,"correct":true,"proposition":"Visual recovery cannot be estimated because the fundus is not visible","justification":"It is necessary to see the state of the retina (which echo B does not allow) to have a prognosis of visual recovery."},{"idx":3,"correct":true,"proposition":"Complications are rare but can lead to loss of function of the eye","justification":""},{"idx":4,"correct":false,"proposition":"The absence of lens will be corrected by a corrective lens","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-11-qi-9","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"The cataract operation does not go as planned. At the time of phacoemulsification, there is a large posterior capsular rupture.  What is (are) the possibility(s) of correction of aphakia in this case?","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Placement of a multifocal implant in the capsular bag","justification":""},{"idx":1,"correct":true,"proposition":"Placement of an anterior chamber implant ","justification":""},{"idx":2,"correct":false,"proposition":"Placement of a monofocal implant in the capsular bag","justification":""},{"idx":3,"correct":true,"proposition":"A correction by a contact lens","justification":""},{"idx":4,"correct":true,"proposition":"A correction by glasses","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-11-qi-10","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"The operation finally tennine well and an anterior chamber implant is placed. Three weeks after the operation the patient consults urgently for a decrease in visual acuity of the left eye associated with a white and painless eye with a calm anterior segment. What diagnosis(s) do you mention?","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Retinal detachment"},{"idx":1,"correct":false,"proposition":"Acute anterior uveitis","justification":""},{"idx":2,"correct":false,"proposition":"Acute post-operative endophthalmitis","justification":""},{"idx":3,"correct":true,"proposition":"Macular edema"},{"idx":4,"correct":false,"proposition":"A clouding of the posterior capsule","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-11-qi-11","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"The visual acuity of the left eye is measured at 5\/10 Parinaud 5 with a correction. Intraocular pressure is measured at 20 mm Hg and examination of the anterior segment is unremarkable. Examination of the fundus finds a loss of foveolar reflection. Which additional exam(s) are you requesting:","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"An examination of the visual field","justification":""},{"idx":1,"correct":false,"proposition":"An ultrasound in mode B","justification":""},{"idx":2,"correct":true,"proposition":"Macular optical coherence tomography (OCT)","justification":"We want to see the macula to objectify an edema of Irvin Gass."},{"idx":3,"correct":false,"proposition":"Visual evoked potentials","justification":""},{"idx":4,"correct":false,"proposition":"An electroretinogram","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-11-qi-12","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"A macular optical coherence tomography (OCT) scan is performed. There is a post-operative macular edema of cataract surgery, which is (are) the exact proposal(s)? ","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"It is of infectious origin","justification":""},{"idx":1,"correct":false,"proposition":"It is accompanied by hemorrhages and cottony nodules","justification":""},{"idx":2,"correct":true,"proposition":"It is of inflammatory origin","justification":""},{"idx":3,"correct":true,"proposition":"It occurs in post-operative weeks or months","justification":""},{"idx":4,"correct":true,"proposition":"Local or loco-regional anti-inflammatory treatment is often effective","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-11-qi-13","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"The patient consults again 3 years later because his visual acuity has deteriorated. It is quantifiable with the left eye at 1\/1O Parinaud 5 with the best optical correction. In this context of post-traumatic cataract and anterior chamber implant, what diagnosis(s) can (s) be evoked to explain this decrease in visual acuity? ","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Posterior vitreous detachment","justification":""},{"idx":1,"correct":true,"proposition":"Corneal edema","justification":""},{"idx":2,"correct":false,"proposition":"Peritasicular drusens","justification":""},{"idx":3,"correct":true,"proposition":"Retinal detachment","justification":""},{"idx":4,"correct":false,"proposition":"Bacterial endophthalmitis","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-12-qi-1","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"After listening to the patient, you seek clarification of certain symptoms.  It seems important to you to look for the presence (or absence) of: ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Epistaxis","justification":""},{"idx":1,"correct":true,"proposition":"Arthralgia","justification":""},{"idx":2,"correct":true,"proposition":"Red eye","justification":""},{"idx":3,"correct":true,"proposition":"Hemoptysis","justification":""},{"idx":4,"correct":true,"proposition":"Dyspnoea","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-12-qi-2","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"The patient confirms the presence of arthralgia. He had no epistaxis or red eye episodes. On the other hand, it is dyspneic and the Sp02 taken during the consultation is 94% in ambient air. Blood pressure is measured at 110\/65 mmHg. The pulse is at 85\/minute. You propose to the patient to carry out biological analyzes. You ask the nurse to sample: ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"A C-reactive protein assay","justification":""},{"idx":1,"correct":true,"proposition":"Blood cultures","justification":""},{"idx":2,"correct":true,"proposition":"A search for antinuclear antibodies","justification":""},{"idx":3,"correct":false,"proposition":"An anticardiolipin antibody assay","justification":""},{"idx":4,"correct":true,"proposition":"A plasma creatinine assay","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-12-qi-3","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"With the clinical context, these results point you towards ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Sjögren's syndrome","justification":""},{"idx":1,"correct":false,"proposition":"Systemic lupus","justification":""},{"idx":2,"correct":false,"proposition":"An antiphospholipid antibody syndrome","justification":""},{"idx":3,"correct":true,"proposition":"Vasculitis","justification":""},{"idx":4,"correct":false,"proposition":"Sarcoidosis","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-12-qi-4","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"You turn to vasculitis and decide to hospitalize the patient in the internal medicine department. The rest of the results arrive quickly especially the C-reactive protein which is at 451 mg \/ L. The available results are shown here. Chronic inflammation alone allows you to explain: ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Microcytosis","justification":""},{"idx":1,"correct":true,"proposition":"Thrombocytosis","justification":""},{"idx":2,"correct":false,"proposition":"Eosinophilia","justification":""},{"idx":3,"correct":true,"proposition":"The increase in alpha-2 globulins","justification":""},{"idx":4,"correct":false,"proposition":"Lymphopenia","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-12-qi-5","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"With regard to ANCAs, it is true that: ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"They are looking for each other in direct immunofluorescence","justification":"Indirect (direct FI refers to solid biopsies)."},{"idx":1,"correct":true,"proposition":"They are mainly directed against myeloperoxidase or proteinase 3","justification":""},{"idx":2,"correct":false,"proposition":"They are directed against the cytoplasm of eosinophilic polynuclear","justification":"PNN"},{"idx":3,"correct":false,"proposition":"They are directed against the cytoplasm of Hep-2 cells","justification":""},{"idx":4,"correct":false,"proposition":"Their positivity in this patient would direct you to vasculitis with deposits of immune complexes","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-12-qi-6","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"The ANCA result and urine strip are shown below. You think you need to:","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Perform an emergency kidney biopsy","justification":""},{"idx":1,"correct":false,"proposition":"Perform an arteriogram before renal biopsy","justification":""},{"idx":2,"correct":false,"proposition":"Contraindicate renal biopsy since ANCA are positive","justification":""},{"idx":3,"correct":true,"proposition":"Perform a kidney ultrasound before biopsy","justification":""},{"idx":4,"correct":false,"proposition":"Perform a uroscan before the biopsy","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-12-qi-7","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"You propose an emergency renal biopsy puncture. This will be carried out: ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Under general anesthesia","justification":"local"},{"idx":1,"correct":true,"proposition":"After obtaining the patient's blood type","justification":"It will be necessary to think about also ticking the RAI if they are proposed"},{"idx":2,"correct":true,"proposition":"With a non-fixed sample for immunofluorescence","justification":""},{"idx":3,"correct":false,"proposition":"Preferably scan-guided","justification":""},{"idx":4,"correct":false,"proposition":"With a sample for electron microscopy (EM)","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-12-qi-8","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"You receive the report of the ACB: ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"This is a histology compatible with pauci-immune vasculitis","justification":""},{"idx":1,"correct":false,"proposition":"The medullary part of the sample allowed the analysis of the glomeruli","justification":"This is the cortical part"},{"idx":2,"correct":false,"proposition":"There is mesangial proliferation","justification":"mesangium is fine"},{"idx":3,"correct":false,"proposition":"There are endomembranous deposits of imrrunoglobulins","justification":"All antibodies are negative"},{"idx":4,"correct":false,"proposition":"There are signs of vascular nephropathy","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-12-qi-9","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"This renal histology is consistent with pauciimmune vasculitis. You propose to treat the patient with: ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Venous corticosteroids","justification":""},{"idx":1,"correct":true,"proposition":"Plasmapheresis (plasma exchange)","justification":""},{"idx":2,"correct":true,"proposition":"Ivermectin","justification":""},{"idx":3,"correct":true,"proposition":"Cyclophosphamide","justification":""},{"idx":4,"correct":false,"proposition":"Aspirin anti-aggregating dose (AAP)","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-12-qi-10","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"In this context, you choose a therapeutic protocol combining cyclophosphamide, corticosteroid therapy and plasmapheresis. You want to inform the patient about the potential toxicities of cyciophosphamide. You explain the risk(s) of:","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Increased renal impairment","justification":""},{"idx":1,"correct":true,"proposition":"Hemorrhagic cystitis"},{"idx":2,"correct":true,"proposition":"Infection"},{"idx":3,"correct":true,"proposition":"Infertility"},{"idx":4,"correct":true,"proposition":"Myelodysplasia"}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-12-qi-11","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"You ask for a chest scan. In these images, you can distinguish: ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Cross-linking","justification":""},{"idx":1,"correct":true,"proposition":"Frosted glass","justification":""},{"idx":2,"correct":false,"proposition":"Excavated nodules","justification":""},{"idx":3,"correct":true,"proposition":"Condensations","justification":""},{"idx":4,"correct":false,"proposition":"From the honeycomb","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-12-qi-12","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"The patient's situation improves after 6 plasma exchanges, corticosteroid therapy (performed by infusion and then relayed at 1 mg \/ kg \/ day orally) and cyclophosphamide. You added cotrimoxazole (trimethoprim-sulfamethoxazole) at a dose appropriate to renal function on day one and the patient received ivennecline at an appropriate dose. It is apyretic, dyspnea has disappeared as well as ENT symptoms. Plasma creatinine stabilizes at 140 μmol\/L. CRP is less than 5 mg\/L. The patient's blood count, 2 weeks before the start of treatment, finds: PNN at 15.87 G \/ L, PNE at 0 G \/ L, PNB at 0 G \/ L, Lymphocytes at 0.84 G \/ L and Monocytes at 0.84 G \/ L. You think the results are related to: ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"a martial deficiency","justification":""},{"idx":1,"correct":true,"proposition":"cyclophosphamide","justification":""},{"idx":2,"correct":true,"proposition":"corticosteroid therapy","justification":""},{"idx":3,"correct":false,"proposition":"an infection","justification":""},{"idx":4,"correct":false,"proposition":"cotrimoxazole","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-12-qi-13","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"Twenty-eight days after the start of treatment, the patient presents with a rash of sudden onset whose photographs are shown to you. C-reactive protein, which was less than 5 mg\/L 72 hours previously, is at 115 mg\/L. Hemoglobin is at 13.5 g \/ dL, platelets at 480 G \/ L, leukocytes at 14 G \/ L (including 10 G \/ L neutrophils, 2 G \/ L eosinophils and 0.9 G \/ L lymphocytes), creatinine is stable at 140 μmol \/ L, AST are at 350 Ul \/ l, ALT at 390 IU \/ L,  gammaglutamyltransferases (GGT) at 390 IU\/L and alkaline phosphatases at 140 IU\/L. Emergency liver ultrasound is normal. You mention ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"A relapse of vasculitis","justification":""},{"idx":1,"correct":false,"proposition":"Generalized acute exanthematous pustulosis","justification":""},{"idx":1,"correct":true,"proposition":"A DRESS Syndrome","justification":""},{"idx":1,"correct":false,"proposition":"Angiocholitis","justification":""},{"idx":1,"correct":false,"proposition":"A parasitic infection on corticosteroids","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-12-qi-14","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"You mention a synctome of hypersensitivity to cotrimoxazole that you stop immediately. The patient's vaccination record tells you that he received a BCG vaccination at 1 month of age (the subsequent tuberculin tests were all negative), a measles-mumps-rubella vaccination (2 injections), and a diphtheria-tetanus-pertussis-poliomyelitis vaccination whose last booster was made when the patient was 25 years old. He tells you that he has never had chickenpox. For prophylactic purposes, you advise vaccinating the patient with ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"An influenza vaccination around October","justification":""},{"idx":1,"correct":true,"proposition":"An anti-pneumococcal vaccination with 2 injections","justification":""},{"idx":2,"correct":false,"proposition":"Vaccination against chickenpox","justification":""},{"idx":3,"correct":true,"proposition":"A DTP booster in the context of immunosuppression","justification":""},{"idx":4,"correct":false,"proposition":"A reminder from BCG","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-13-qi-1","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"Regarding legislation on sexual violence, what is the exact proposal(s)? ","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Rape is sexual assault","justification":""},{"idx":1,"correct":true,"proposition":"Forced fellatio can be considered rape","justification":""},{"idx":2,"correct":false,"proposition":"Rape does not exist between spouses","justification":""},{"idx":3,"correct":true,"proposition":"Rape is any act of sexual penetration carried out under threat, coercion or surprise","justification":"This is the definition in the Penal Code."},{"idx":4,"correct":false,"proposition":"A vulvar caress can be considered rape","justification":"No penetration = not rape."}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-13-qi-2","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"This girl is alone, tells you she is ashamed, and wishes that neither her parents nor anyone around her knew what happened. What is the course of action? (only one exact answer) ","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"You don't look at her until she files a complaint","justification":""},{"idx":1,"correct":true,"proposition":"You ask him to bring an adult of his choice to participate in his care","justification":""},{"idx":2,"correct":false,"proposition":"You tell his parents","justification":""},{"idx":3,"correct":false,"proposition":"You only do the integumentary examination but not the gynecological examination","justification":""},{"idx":4,"correct":false,"proposition":"You immediately notify the police","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-13-qi-3","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"The victim was joined by the 40-year-old mother of a friend. The victim asks you for a medical certificate. What is the exact proposal(s)? ","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"This document is essential if she wishes to file a complaint","justification":""},{"idx":1,"correct":true,"proposition":"You give him the medical certificate, in the presence of the adult of his choice","justification":""},{"idx":2,"correct":false,"proposition":"You give the medical certificate to the judicial police officer on duty at the police station","justification":""},{"idx":3,"correct":false,"proposition":"In case of judicial requisition, you give this certificate to the judicial police officer only if the young woman agrees","justification":""},{"idx":4,"correct":false,"proposition":"If the filing of a complaint is uncertain, the issuance of a medical certificate is not possible","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-13-qi-4","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"What is (are) the method(s) of drafting the medical certificate? ","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The medical editor mentions his identity","justification":""},{"idx":1,"correct":false,"proposition":"The victim must prove his identity to the doctor by giving him an identity document","justification":""},{"idx":2,"correct":false,"proposition":"The doctor certifies that the facts reported are credible","justification":""},{"idx":3,"correct":true,"proposition":"The absence of gynaecological traumatic injury must be mentioned in the certificate","justification":""},{"idx":4,"correct":false,"proposition":"Sexual violence results in total incapacity for work of more than eight days","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-13-qi-5","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"At the end of the clinical examination, which additional examination(s) do you request?","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Determination of b-HCG","justification":""},{"idx":1,"correct":true,"proposition":"HIV serology 1 and 2","justification":""},{"idx":2,"correct":true,"proposition":"HBV serology","justification":""},{"idx":3,"correct":true,"proposition":"HCV serology","justification":""},{"idx":4,"correct":true,"proposition":"Syphilis serology","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-13-qi-7","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"The information you give her persuades the girl to file a complaint to complete your judicial report. You contact the Police. The judicial police officer (OPJ) explains that a police team will come to bring you a document and wait at the hospital for the end of your examination. What is this document? (only one exact answer) ","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"An interim care order","justification":""},{"idx":1,"correct":false,"proposition":"A letter rogatory","justification":""},{"idx":2,"correct":false,"proposition":"A report of filing a complaint","justification":""},{"idx":3,"correct":true,"proposition":"A judicial requisition","justification":""},{"idx":4,"correct":false,"proposition":"An extract from the criminal record","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-13-qi-8","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"You are requisitioned by the judicial police officer to carry out the examination of the victim and any useful samples. In this context, what sample(s) can you carry out? ","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Bite swabs","justification":""},{"idx":1,"correct":true,"proposition":"Swabs at the vaginal level","justification":""},{"idx":2,"correct":true,"proposition":"Anal swabs","justification":""},{"idx":3,"correct":true,"proposition":"Swabs at the mouth level","justification":""},{"idx":4,"correct":false,"proposition":"Swabs from the nasal cavities","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-13-qi-9","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"At the end of your examination, the judicial police officer wants to know the number of days of total incapacity for work. Regarding total incapacity for work in the criminal sense for this patient, what is (are) the exact proposal(s)? ","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Total incapacity for work must be mentioned on the medical certificate","justification":""},{"idx":1,"correct":true,"proposition":"Total incapacity for work in the criminal sense corresponds to functional discomfort in carrying out the gestures of daily life","justification":""},{"idx":2,"correct":false,"proposition":"Total incapacity for work in the criminal sense corresponds to the number of days of absence from work","justification":""},{"idx":3,"correct":false,"proposition":"Total incapacity for work does not apply to minors","justification":""},{"idx":4,"correct":false,"proposition":"Total incapacity for work only makes sense if it is strictly greater than 8 days","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-13-qi-10","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"What treatment(s) can you urgently prescribe to this girl, with her agreement and that of the adult accompanying her? ","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"HPV vaccination","justification":""},{"idx":1,"correct":true,"proposition":"Triple anti-retroviral therapy","justification":""},{"idx":2,"correct":true,"proposition":"Emergency contraception","justification":""},{"idx":3,"correct":false,"proposition":"Antidepressant treatment that inhibits serotonin reuptake","justification":""},{"idx":4,"correct":true,"proposition":"Azithromycin antibiotic prophylaxis","justification":"In prevention of infection with Chlamydia trachomatis (in 2022, treatment is based on Doxycicline 8 days)."}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-13-qi-11","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"What element(s) should be included in the information to be provided to the victim? ","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Known side effects of treatments","justification":""},{"idx":1,"correct":true,"proposition":"Methods of monitoring processing","justification":""},{"idx":2,"correct":true,"proposition":"Risks in case of refusal of treatment","justification":""},{"idx":3,"correct":true,"proposition":"Contact details of a victim support association","justification":""},{"idx":4,"correct":true,"proposition":"The need for safe sex during HAART","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-13-qi-12","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"Four days later, the victim has side effects following taking triple antiretroviral therapy. She is furious because she says she was not informed of these effects. Regarding medical information, what is the exact proposal(s)? ","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"The burden of proof of information lies with the patient initiating a procedure","justification":""},{"idx":1,"correct":true,"proposition":"The information must be delivered orally","justification":""},{"idx":2,"correct":false,"proposition":"The information must be provided in writing","justification":"It is possible but not necessary."},{"idx":3,"correct":true,"proposition":"Information must be fair, clear and appropriate","justification":""},{"idx":4,"correct":false,"proposition":"A confirmation of the delivery of the information must be signed by the patient","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-13-qi-13","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"The girl comes back to see you, pregnant with 9 weeks of amenorrhea, as a result of sexual violence, she tells you. What is the exact proposal(s) ","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Parental consent is required to carry out a voluntary termination of pregnancy","justification":""},{"idx":1,"correct":false,"proposition":"The girl may be accompanied by an adult of her choice for the different stages of the voluntary termination of pregnancy","justification":""},{"idx":2,"correct":false,"proposition":"The girl can benefit from a voluntary termination of pregnancy by medical means","justification":"The limit is 7 SA for the drug route. This duration may change in the coming months\/years, remember to check the latest recommendations of the HAS (and do not hesitate to let us know this proposal if it becomes true)."},{"idx":3,"correct":false,"proposition":"The girl can wait up to a term of 16 weeks of amenorrhea to request a voluntary termination of pregnancy","justification":""},{"idx":4,"correct":false,"proposition":"Due to the context, the cooling-off period is cancelled","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-14-qi-1","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"In the table of this patient, which of the following parameter(s) is (are) suggestive of sepsis with poor prognosis? ","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Temperature","justification":""},{"idx":1,"correct":true,"proposition":"Respiratory rate","justification":""},{"idx":2,"correct":false,"proposition":"Heart rate","justification":""},{"idx":3,"correct":false,"proposition":"Blood pressure","justification":""},{"idx":4,"correct":true,"proposition":"Score de Glasgow","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-14-qi-2","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"What is your immediate attitude? ","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"High concentration mask oxygen therapy","justification":""},{"idx":1,"correct":false,"proposition":"Establishment of a central venous first route","justification":""},{"idx":2,"correct":false,"proposition":"Filling with synthetic macromolecules (1L on the first hour)","justification":"Colloids are no longer used to fill patients (very limited indications in intensive care, this is not to be known for NEC)."},{"idx":3,"correct":false,"proposition":"Administration of vasopressive amines","justification":""},{"idx":4,"correct":false,"proposition":"Antibiotic therapy with ceftriaxone","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-14-qi-3","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"Which of the following exam(s) is part of your first-line assessment? ","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Chest X-ray","justification":""},{"idx":1,"correct":false,"proposition":"Bronchoalveolar lavage","justification":""},{"idx":2,"correct":false,"proposition":"Coproculture","justification":""},{"idx":3,"correct":true,"proposition":"Blood","justification":""},{"idx":4,"correct":true,"proposition":"Legionella antigenacuria","justification":"As well as pneumococcus"}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-14-qi-4","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"The CBC targets anemia at 121 g\/L, leukocytosis at 4600 G\/L (including 3800 PNN), CRP at 254 mg\/L and PCT at 3.5 μg\/L. The ionogram is normal, kidney function is normal. Arterial blood gases under nasal oxygen 6L\/min are: pH 7.45 - pC02 30 mmHg - p02 65 mmHg - HC03- 25 mmol \/ L. A chest CT scan is performed immediately. What is your interpretation of this scanner? ","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Interstitial syndrome","justification":""},{"idx":1,"correct":false,"proposition":"Pleural effusion","justification":""},{"idx":2,"correct":true,"proposition":"Alveolar condensation","justification":""},{"idx":3,"correct":false,"proposition":"Pericardial effusion","justification":""},{"idx":4,"correct":false,"proposition":"Caves","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-14-qi-5","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"Blood cultures are ongoing and legionella antigenuria is negative. Which of the following infectious agents may be responsible for this picture at this stage of your investigations?","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Streptococcus pneumoniae","justification":""},{"idx":1,"correct":true,"proposition":"Legionnella pneumophila","justification":"Which would be serotype 2 here (not detected by antigenuria, which can also be falsely negative)."},{"idx":2,"correct":false,"proposition":"Clostridium dificult","justification":""},{"idx":3,"correct":true,"proposition":"Pneumocystis jirovecii","justification":""},{"idx":4,"correct":true,"proposition":"Myxovirus influenzae","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-14-qi-6","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"The patient is immediately transferred to intensive care where he is immediately intubated in the face of respiratory exhaustion. Do you prescribe anti-infective treatment(s) at this stage?","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Cefotaxime","justification":""},{"idx":1,"correct":false,"proposition":"Amoxicillin","justification":""},{"idx":2,"correct":true,"proposition":"Spiramycin","justification":""},{"idx":3,"correct":true,"proposition":"Oseltamivir","justification":""},{"idx":4,"correct":false,"proposition":"Pristinamycin","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-14-qi-7","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"The probabilistic anti-infective treatment implemented combines cefotaxime, spiramycin and oseltamivir. A bronchoalveolar lavage is quickly performed. It highlights many cysts of Pneumocystis jirovecii. How do you adjust your treatment knowing that you are diagnosed with pneumocystosis? ","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Intravenous fluconazole","justification":""},{"idx":1,"correct":true,"proposition":"High-dose intravenous cotrimoxazole","justification":""},{"idx":2,"correct":false,"proposition":"Fidaxomicin aerosol","justification":""},{"idx":3,"correct":true,"proposition":"Corticosteroid therapy","justification":"PAO2 is less than 70 mmHg. Corticosteroid therapy will reduce fibrosis due to inflammatory overstimulation."},{"idx":4,"correct":false,"proposition":"Intravenous ketoprofen","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-14-qi-8","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"In view of this diagnosis, an HIV serology has been performed and is positive. What additional exam(s) do you perform?","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"CD4\/CD8 lymphocyte subpopulations","justification":""},{"idx":1,"correct":true,"proposition":"HIV viral load","justification":""},{"idx":2,"correct":false,"proposition":"Hepatitis E virus (HEV) serology","justification":""},{"idx":3,"correct":true,"proposition":"Toxoplasmosis serology","justification":""},{"idx":4,"correct":false,"proposition":"Syphilis serology","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-14-qi-9","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"With cotrimoxazole and corticosteroids, the patient's condition improves rapidly and he is extubated after 48 hours. He began to refeed orally. No other infectious agents were identified in all the samples taken. CD4 count is 19\/mm3 (4.8%) and viral load is 159,000 copies\/ml. On Day 4 of the management, concerning antiretroviral treatment, which of the following proposals is accurate? ","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Introduction of dual therapy with protease inhibitor and entry inhibitor","justification":""},{"idx":1,"correct":false,"proposition":"Introduction of triple therapy with protease inhibitors and two non-nucleoside reverse transcriptase inhibitors","justification":""},{"idx":2,"correct":false,"proposition":"Introduction of triple therapy with protease inhibitor and two nucleoside reverse transcriptase inhibitors","justification":""},{"idx":3,"correct":false,"proposition":"Introduction of triple therapy with integrase inhibitor and two nucleoside reverse transcriptase inhibitors","justification":""},{"idx":4,"correct":true,"proposition":"No antiretroviral therapy at this stage","justification":"We'll let him recover from his lung infection first ☺️"}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-14-qi-10","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"The trend continues to be favourable with cotrimoxazole. Corticosteroids were discontinued on Day 6 and antiretroviral therapy was not initiated. On Day 10 of the treatment, the fever reappears with a scarlatiniform rash of the trunk and face. What is (are) your hypothesis(s)? ","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Pneumocystis resistance to cotrimoxazole","justification":""},{"idx":1,"correct":true,"proposition":"Allergy to cortimoxazole","justification":""},{"idx":2,"correct":false,"proposition":"Rebound of pneumocystosis following discontinuation of corticosteroids","justification":""},{"idx":3,"correct":false,"proposition":"Immune restoration syndrome","justification":"Antiretrovirals have not yet been started."},{"idx":4,"correct":false,"proposition":"Staphylococcal toxic shock syndrome","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-14-qi-11","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"The hypothesis of an allergy to cotrimoxazole is retained. What sign(s) of gravity are you looking for? ","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Positive Nikolsky sign","justification":""},{"idx":1,"correct":false,"proposition":"Maculopapular rash","justification":"This is not especially a sign of gravity"},{"idx":2,"correct":true,"proposition":"Edema of the face","justification":""},{"idx":3,"correct":true,"proposition":"Associated mucosal erosions","justification":""},{"idx":4,"correct":false,"proposition":"Hearing loss","justification":"No report"}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-14-qi-12","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"There is no sign of severity and the rash regresses within a few days following the reduction of cotrimoxazole doses. You decide on Day 15 to introduce antiretroviral treatment. Which of the following will be useful for the choice of initial antiretroviral therapy? ","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Search for the HLA B57*01 allele","justification":""},{"idx":1,"correct":true,"proposition":"Genotypic HIV resistance test","justification":""},{"idx":2,"correct":true,"proposition":"Hepatitis B serology","justification":""},{"idx":3,"correct":false,"proposition":"Syphilis serology","justification":""},{"idx":4,"correct":false,"proposition":"Plasma testing of antiretrovirals","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-14-qi-13","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"The result of HBV serology is as follows: HBsAg positive, HBeAg positive, anti-HBc IgM negative, anti-HBc IgG positive, anti-HBe antibodies and HBs negative. HBV DNA PCR is high (10 million Ul\/ml) and transaminases are 2.5 times the norm. Which of the following is correct?","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"It is probably acute hepatitis B","justification":""},{"idx":1,"correct":true,"proposition":"It is a hepatitis B virus without pre-core mutation","justification":"The HBe antigen is positive so it is not mutated"},{"idx":2,"correct":true,"proposition":"Antiretroviral therapy should ideally include tenofovir","justification":""},{"idx":3,"correct":false,"proposition":"Ribavirin should be added to antiretroviral therapy","justification":"ribavirin is active against HCV"},{"idx":4,"correct":false,"proposition":"HBV serovaccination should also be given to the patient","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-14-qi-14","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"Triple antiretroviral therapy is initiated on Day 15. Which of the following proposals for support after D15 is correct? ","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Continuation of cotrimoxazole treatment at current doses for another week","justification":""},{"idx":1,"correct":true,"proposition":"Secondary prophylaxis (after the end of attack therapy) low-dose anti-pneumocystosis ar cotrimoxazole","justification":""},{"idx":2,"correct":false,"proposition":"Initiation of primary prophylaxis of esophageal candidiasis with fluconazole","justification":""},{"idx":3,"correct":false,"proposition":"Initiation of primary anti-toxoplasmosis prophylaxis with low-dose pyrimethamine","justification":""},{"idx":4,"correct":false,"proposition":"Maintenance of primary toxoplasmosis and secondary pneumocystosis prophylaxis for 2 years","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-14-qi-15","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"What other measure(s) can you personally take? ","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Information for sexual partners","justification":""},{"idx":1,"correct":false,"proposition":"Nominative declaration to the ARS","justification":"anonymous"},{"idx":2,"correct":true,"proposition":"Declaration of long-term illness (100%)","justification":"ALD 7"},{"idx":3,"correct":false,"proposition":"Declaration to occupational medicine","justification":""},{"idx":4,"correct":true,"proposition":"Proposal for psychological follow-up","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-15-qi-1","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"Which lesional location(s) do you think are likely? ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Left Thalamic","justification":""},{"idx":1,"correct":true,"proposition":"Left frontal","justification":""},{"idx":2,"correct":false,"proposition":"Right midbrain","justification":""},{"idx":3,"correct":false,"proposition":"Left Capsular","justification":""},{"idx":4,"correct":true,"proposition":"Left parietal","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-15-qi-2","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"What is your immediate care ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Realization of a Doppler ultrasound of the supra-aortic trunks","justification":""},{"idx":1,"correct":true,"proposition":"Support by the neurovascular sector","justification":""},{"idx":2,"correct":true,"proposition":"Performing a brain MRI","justification":""},{"idx":3,"correct":false,"proposition":"Initiation of antihypertensive therapy","justification":"High blood pressure figures are tolerated in ischemic stroke."},{"idx":4,"correct":false,"proposition":"Initiation of antiplatelet therapy","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-15-qi-3","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"What sequence(s) should the MRI include? ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"T1 with gadolinium injection","justification":""},{"idx":0,"correct":false,"proposition":"T2","justification":""},{"idx":0,"correct":true,"proposition":"T2 FLAIR","justification":""},{"idx":0,"correct":true,"proposition":"Broadcast sequence (DWI)","justification":""},{"idx":0,"correct":true,"proposition":"3D TOF (angio-MRI, Time Of Flight)","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-15-qi-4","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"Here are two images of the MRI performed: ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Left sylvian hypersignal in FLAIR sequence","justification":""},{"idx":1,"correct":true,"proposition":"Right occipital hypersignal in FLAIR sequence","justification":""},{"idx":2,"correct":true,"proposition":"Left sylvian hypersignal in diffusion sequence","justification":""},{"idx":3,"correct":false,"proposition":"Right silvian hypersignal in diffusion sequence","justification":""},{"idx":4,"correct":false,"proposition":"Left sylvian hyposignal in scattering sequence","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-15-qi-5","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"Brain MRI reveals a recent lesion visible in diffusion sequence in the superficial left sylvian territory. It also finds a hypersignal in FLAIR sequence in the right, ancient occipital territory. There is no bleeding lesion or obstruction of the proximal large vessels. In view of these MRI results and the clinical context, which pathophysiological hypothesis do you think is most likely? (only one answer expected) ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Left carotid dissection","justification":""},{"idx":1,"correct":false,"proposition":"Microangiopathy","justification":""},{"idx":2,"correct":false,"proposition":"Cerebral arteritis","justification":""},{"idx":3,"correct":true,"proposition":"Embologenic heart disease","justification":""},{"idx":4,"correct":false,"proposition":"Atheroma","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-15-qi-6","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"What is your immediate therapeutic proposal? (only one answer expected) ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Parenteral antiplatelet agents","justification":""},{"idx":1,"correct":false,"proposition":"Unfractionated parenteral hypocoagulant heparin","justification":""},{"idx":2,"correct":false,"proposition":"New oral anticoagulants","justification":""},{"idx":3,"correct":true,"proposition":"Intravenous thrombolysis by rt PA","justification":""},{"idx":4,"correct":false,"proposition":"Thrombectomy","justification":"We are not in a case of late time. In addition, the clot is not proximal, which would make thrombectomy complicated."}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-15-qi-7","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"Following the MRI, the patient was admitted to the neurovascular unit (UNV) and underwent intravenous thrombotyposis. The motor deficit has partially recovered, phasic disorders persist. What is(are) the element(s) of your prescription during the first 24 hours? ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Antihypertensive treatment","justification":""},{"idx":1,"correct":false,"proposition":"Lift allowed","justification":""},{"idx":2,"correct":true,"proposition":"Subcutaneous insulin therapy if blood glucose above 1.8 g\/L","justification":""},{"idx":3,"correct":false,"proposition":"Transcranial Doppler","justification":""},{"idx":4,"correct":true,"proposition":"Multiple daily clinical monitoring by NIHSS score","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-15-qi-8","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"At 48 hours of evolution, the patient remains aphasiac. There persists a predominant distal right brachial motor deficit and oral feeding is resumed without discomfort. He did not present any complications. What is (are) the objective(s) of physiotherapy management at this stage? ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Analytical reinforcement of motor skills","justification":""},{"idx":1,"correct":false,"proposition":"Breathing decluttering exercises","justification":""},{"idx":2,"correct":false,"proposition":"Sensory awakening work","justification":""},{"idx":3,"correct":false,"proposition":"Deep transverse massages","justification":""},{"idx":4,"correct":false,"proposition":"Passive mobilizations of the lower right limb","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-15-qi-9","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"To confirm your main etiological hypothesis, you prescribe ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"A Doppler ultrasound of the supra-aortic trunks","justification":""},{"idx":1,"correct":true,"proposition":"A trans-thoracic cardiac ultrasound","justification":""},{"idx":2,"correct":true,"proposition":"Transesophageal cardiac ultrasound","justification":""},{"idx":3,"correct":true,"proposition":"An ECG holter","justification":""},{"idx":4,"correct":false,"proposition":"A tensional holter","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-15-qi-10","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"This patient has Broca's aphasia. Which characteristic(s) are compatible with this diagnosis?","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Presence of paraphasies"},{"idx":1,"correct":true,"proposition":"Impaired fluence"},{"idx":2,"correct":true,"proposition":"Normal comprehension"},{"idx":3,"correct":false,"proposition":"Normal written expression"},{"idx":4,"correct":false,"proposition":"Agnosia"}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-15-qi-11","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"The holter ECG shows paroxysmal atrial fibrillation. Cardiac ultrasound (transthoracic and transesophageal) and Doppler ultrasound of the supraaortic trunks are normal. The lipid and glycemic balance is normal. Blood pressure normalized. What is (are) the element(s) of your exit prescription? ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"ACE inhibitor","justification":""},{"idx":1,"correct":false,"proposition":"Statine","justification":""},{"idx":2,"correct":true,"proposition":"Oral anticoagulant","justification":""},{"idx":3,"correct":false,"proposition":"Antiplatelet agent","justification":""},{"idx":4,"correct":false,"proposition":"Loop diuretic","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-15-qi-12","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"What is(are) your non-drug prescription (s)? ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Speech therapy","justification":""},{"idx":1,"correct":true,"proposition":"Work stoppage","justification":""},{"idx":1,"correct":false,"proposition":"First category invaladity","justification":"Not acute because the patient can continue to recover"},{"idx":1,"correct":false,"proposition":"Safeguarding justice","justification":""},{"idx":1,"correct":true,"proposition":"Physiotherapy assessment","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-15-qi-13","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"You see the patient again in follow-up consultation at 3 months. There is still clumsiness in the right hand and a reduction in fluency, as well as fatigability. He is autonomous for most activities of daily living but has not been able to resume his professional activity. He also complains of attention and sleep disorders, his weight is 65 kg. He continues his anticoagulantoral treatment with anti-vitamin K. What is your diagnostic orientation in the face of this clinical evolution (only one expected response) ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Recurrent ischemic stroke","justification":""},{"idx":1,"correct":false,"proposition":"Side effects of drug treatment","justification":""},{"idx":2,"correct":false,"proposition":"Vascular epilepsy","justification":""},{"idx":3,"correct":true,"proposition":"Depressive syndrome","justification":""},{"idx":4,"correct":false,"proposition":"Deficiency","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-15-qi-14","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"What medico-social measure(s) can you propose? ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Constitution of a file with the Departmental House of Disabled Persons for allocation of the Disabled Adult Allowance (AAH)","justification":""},{"idx":1,"correct":true,"proposition":"Preparation of a file with the Departmental House of Persons with Disabilities for recognition of quality disabled worker","justification":""},{"idx":2,"correct":false,"proposition":"First category invaladity","justification":""},{"idx":2,"correct":true,"proposition":"Renewal of the stoppage of work","justification":""},{"idx":2,"correct":false,"proposition":"Declaration of occupational disease","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-15-qi-15","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"Regarding his long-term oral anticoagulant treatment, which is(are) the exact proposal(s)? ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"The target INR is between 2.5 and 3.5","justification":""},{"idx":1,"correct":true,"proposition":"The INR control must be at least monthly","justification":""},{"idx":2,"correct":true,"proposition":"An INR around 2 allows dental care","justification":""},{"idx":3,"correct":true,"proposition":"In case of hemorrhage, PPSB acts faster than vitamin K","justification":""},{"idx":4,"correct":false,"proposition":"In case of INR at 5, vitamin K intake is recommended","justification":"If he is asymptomatic, he simply has to skip a catch."}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-16-qi-1","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"What diagnosis(s) do you suspect? ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Guttate psoriasis","justification":""},{"idx":1,"correct":false,"proposition":"Erythema multiforme","justification":""},{"idx":2,"correct":false,"proposition":"Primary HIV infection","justification":""},{"idx":3,"correct":true,"proposition":"Secondary syphilis","justification":""},{"idx":4,"correct":false,"proposition":"Dermatophytia","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-16-qi-2","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"You suspect secondary syphilis. Which symptom(s) or examination sign(s) presented by the patient is (are) suggestive with this diagnosis? ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The localization on the trunk of the eruption","justification":""},{"idx":1,"correct":true,"proposition":"Asthenia","justification":""},{"idx":2,"correct":true,"proposition":"Polyadenopathy","justification":""},{"idx":3,"correct":true,"proposition":"Transient nature of trunk rash","justification":""},{"idx":4,"correct":false,"proposition":"Apyrexia","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-16-qi-3","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"Which of the following symptoms can also be highlighted in secondary syphilis? ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Polyarthralgia","justification":""},{"idx":1,"correct":true,"proposition":"Facial paralysis","justification":""},{"idx":2,"correct":true,"proposition":"Hearing loss","justification":""},{"idx":3,"correct":true,"proposition":"Uveitis","justification":"This is the famous 'big simulator'"},{"idx":4,"correct":false,"proposition":"Recurrent cystitis","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-16-qi-4","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"To reinforce your diagnosis, you look for the existence of symptomatic primary syphilis that preceded the current rash. Which of the following proposals for syphilitic chancro is (are) accurate? ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"It is painful","justification":""},{"idx":1,"correct":true,"proposition":"It is most often unique","justification":""},{"idx":2,"correct":true,"proposition":"It is accompanied by lymphadenopathy","justification":""},{"idx":3,"correct":false,"proposition":"It is soft in consistency","justification":"It is endured"},{"idx":4,"correct":true,"proposition":"It can be of pharyngeal localization","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-16-qi-5","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"You do not find at the interrogation any element in favor of a syphilitic chancre. The patient informs you, however, that he was diagnosed with syphilis 10 years ago and that he received treatment. Which of the following tests do you request to confirm the diagnosis of secondary syphilis?","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"TPHA","justification":""},{"idx":1,"correct":false,"proposition":"Blood count","justification":""},{"idx":2,"correct":false,"proposition":"Skin biopsy","justification":""},{"idx":3,"correct":true,"proposition":"VDRL","justification":""},{"idx":4,"correct":false,"proposition":"Cultivation of a swab made on the palm","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-16-qi-6","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"The TPHA is positive (+++) and the VDRL is 1\/64. In context, what interpretation(s) do you make of it? ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Previously treated syphilis serological scar","justification":""},{"idx":1,"correct":false,"proposition":"Very early syphilis","justification":""},{"idx":2,"correct":false,"proposition":"False positive","justification":""},{"idx":3,"correct":true,"proposition":"Untreated secondary syphilis","justification":""},{"idx":4,"correct":false,"proposition":"Non-venereal treponematosis","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-16-qi-7","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"Apart from syphilis, what is the situation(s) where a VDRL can be positive?","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Lupus","justification":""},{"idx":1,"correct":true,"proposition":"Anti-phospholipid antibody syndrome","justification":""},{"idx":2,"correct":true,"proposition":"Non-venereal treponematosis","justification":""},{"idx":3,"correct":true,"proposition":"Leprosy","justification":""},{"idx":4,"correct":true,"proposition":"Borreliosis","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-16-qi-8","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"Apart from syphilis, what is the situation(s) where APHD can be positive? ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Lupus","justification":""},{"idx":1,"correct":false,"proposition":"Anti-phospholipid antibody syndrome","justification":""},{"idx":2,"correct":true,"proposition":"Non-venereal treponematosis","justification":""},{"idx":3,"correct":false,"proposition":"Leprosy","justification":""},{"idx":4,"correct":false,"proposition":"Borreliosis","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-16-qi-9","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"You are looking for another sexually transmitted disease(s) in this patient. Which exam(s) are you requesting? ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Hepatitis B serology","justification":""},{"idx":1,"correct":false,"proposition":"Serology Mycoplasma hominis","justification":"We don't track that"},{"idx":2,"correct":false,"proposition":"Serology Chlamydia trachomatis","justification":"Is done by PCR"},{"idx":3,"correct":false,"proposition":"Serology Neisseria gonorrhoae","justification":"Is done by PCR"},{"idx":4,"correct":true,"proposition":"HIV serology","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-16-qi-10","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"Because the patient is HIV-negative, what treatment(s) do you put in place, in the absence of drug allergy, to treat secondary syphilis?","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Ceftriaxone 500 mg, single intramuscular administration","justification":"Treatment of gonococci"},{"idx":1,"correct":false,"proposition":"Azithromycin 1 g, single oral administration","justification":"Treatment of Chlamydia trachomatis (today it is Doxycicline 8 days in first line)"},{"idx":2,"correct":true,"proposition":"Benzathine benzylpenicillin G 2.4 MUI, single intramuscular administration","justification":""},{"idx":3,"correct":false,"proposition":"Penicillin G 20 MUI, intravenous administration for 15 days","justification":"Neurosyphilis"},{"idx":4,"correct":false,"proposition":"Doxycycline 200 mg, single oral administration","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-16-qi-11","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"The patient received a single injection of benzathine benzylpeflicillin G 2.4 MUI. A few hours later, he complained of headaches and myalgia. The temperature is 38°C and lesions on the palms and plants appear more numerous and larger. What diagnosis(s) do you mention? ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Drug urticaria","justification":""},{"idx":1,"correct":false,"proposition":"Fixed pigmented erythema","justification":""},{"idx":2,"correct":false,"proposition":"Taxidermy with macula-papular exanthema type","justification":""},{"idx":3,"correct":true,"proposition":"Reaction to treponeme lysis","justification":""},{"idx":4,"correct":false,"proposition":"Drug-induced hypersensitivity syndrome (DRESS)","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-16-qi-12","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"In order to ensure the effectiveness of benzathine benzylpenicillin G 2,4 MIU treatment, when should you recheck TPHA and VDRL in this patient? (one or more correct answers) ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"15 days","justification":""},{"idx":1,"correct":false,"proposition":"1 month","justification":""},{"idx":2,"correct":false,"proposition":"Serological monitoring is not necessary","justification":""},{"idx":3,"correct":true,"proposition":"6 months","justification":""},{"idx":4,"correct":true,"proposition":"1 year","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-16-qi-13","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"The questioning of the patient taught you about the existence of several partners in the previous months, without protection from sexual intercourse. Only his most recent partner was able to be contacted by the patient and present for consultation. The last unprotected sex between them was 3 weeks ago. TPHA and VDRL are negative. What is the possible interpretation(s) of the partner's serology? ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":" Absence of syphilis","justification":""},{"idx":1,"correct":true,"proposition":"Very recent syphilis","justification":""},{"idx":2,"correct":false,"proposition":"Secondary syphilis","justification":""},{"idx":3,"correct":false,"proposition":"Tertiary syphilis","justification":""},{"idx":4,"correct":false,"proposition":"Non-venereal treponematosis","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-16-qi-14","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"What can you offer this partner? ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"A serological check 3 months later","justification":""},{"idx":1,"correct":true,"proposition":"An injection of benzathine benzylpenicillin G, after checking for allergy","justification":""},{"idx":2,"correct":false,"proposition":"Serological control is not necessary","justification":""},{"idx":3,"correct":true,"proposition":"Protected sex","justification":""},{"idx":4,"correct":false,"proposition":"Sexual abstinence","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-16-qi-15","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"You see the patient again 6 months after treatment of secondary syphilis with benzathine benzylpenicillin G 2.4 M. It is asymptomatic and the rash is gone. The VDRL is 1\/16, the TPHA is positive (+). As a reminder, in pre-therapeutics, the TPHA was positive (+++) and the VDRL was 1\/64. What interpretation(s) do you make? ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Recontamination","justification":""},{"idx":1,"correct":false,"proposition":"Treatment resistance","justification":""},{"idx":2,"correct":true,"proposition":"Healing","justification":""},{"idx":3,"correct":false,"proposition":"Non-venereal treponematosis","justification":""},{"idx":4,"correct":false,"proposition":"Need for a new injection of benzathine benzylpenicillin G 2,4 MIU","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-17-qi-1","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"Which additional exam(s) are you considering? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Serum vitamin B12 assay","justification":""},{"idx":1,"correct":true,"proposition":"Reticulocyte count","justification":""},{"idx":2,"correct":true,"proposition":"Myelogram","justification":"The statement does not speak of first intention, so it is true since the myelogram is well envisaged in the prse in charge of a potentially central anemia."},{"idx":3,"correct":false,"proposition":"Tongue biopsy","justification":""},{"idx":4,"correct":true,"proposition":"Serum vitamin 89","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-17-qi-2","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"The reticulocyte count is 70 OOO\/mm3. A myelogram is performed. The examination finds the presence of a rich marrow, with erythroblasts of large size, an asynchrony of nucleocytoplasmic maturation, the presence of giant metamyelocytes and hypersegmented polynuclear cells. There is no excess of blasts. What is your diagnosis? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Myelodysplastic syndrome","justification":""},{"idx":1,"correct":false,"proposition":"Acute leukemia","justification":""},{"idx":2,"correct":false,"proposition":"Bone marrow suppression","justification":""},{"idx":3,"correct":true,"proposition":"Megaloblastic anemia","justification":""},{"idx":4,"correct":false,"proposition":"Anemia","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-17-qi-3","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"The requested assessment finds a serum concentration of vitamin B12 at 75 ng \/ L (N>200). The dosage of vitamin B9 is normal. Which additional exam(s) do you prescribe to complete the assessment? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Determination of anti-transglutaminase antibodies","justification":""},{"idx":1,"correct":false,"proposition":"Determination of anti-nuclear antibodies","justification":""},{"idx":2,"correct":false,"proposition":"Enteroscanner with contrast injection","justification":""},{"idx":3,"correct":true,"proposition":"Determination of anti-intrinsic factor antibodies","justification":""},{"idx":4,"correct":true,"proposition":"Upper GI endoscopy","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-17-qi-4","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"Anti-intrinsic factor antibodies are absent and upper gastrointestinal endoscopy finds pallor of the mucous membrane of the antrum and gastric body with excessive visibility of the small vessels. There is no esophagitis. Samples taken from the gastric body and the antrum reveal a rarefaction of the density of the glands with the presence of sectors of the epithelium consisting of intestinal type cells. Absence of visible pathogen. There is in the chorion a moderate lymphoplasmacytic infiltrate without neutrophil polynuclear. What is the real proposal(s)? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Pangastric glandular atrophy","justification":""},{"idx":1,"correct":true,"proposition":"Biermer's disease","justification":""},{"idx":2,"correct":false,"proposition":"Lymphocytic gastritis","justification":""},{"idx":3,"correct":false,"proposition":"Active inflammatory gastritis","justification":""},{"idx":4,"correct":true,"proposition":"Chronic gastritis with intestinal metaplasia","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-17-qi-5","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"What is (are) in this patient the predisposing factor(s) to this atrophic pangastritis with intestinal metaplasia? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"An autoimmune pathology","justification":""},{"idx":0,"correct":true,"proposition":"the sequelae of a Helicobacter pylori infection","justification":""},{"idx":0,"correct":true,"proposition":"Tobacco","justification":""},{"idx":0,"correct":false,"proposition":"An autoimmune pathology","justification":""},{"idx":0,"correct":false,"proposition":"Taking proton pump inhibitors","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-17-qi-6","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"What consequence(s) does this atrophic gastritis with intestinal metaplasia expose? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Risk of gastric adenocarcinoma","justification":""},{"idx":1,"correct":true,"proposition":"Iron deficiency","justification":""},{"idx":2,"correct":false,"proposition":"Gastric lymphoma","justification":""},{"idx":3,"correct":false,"proposition":"Duodenal ulcer","justification":""},{"idx":4,"correct":true,"proposition":"Gastric ulcer","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-17-qi-7","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"Seven years later, the then 58-year-old patient consulted the Emergency Department for ascites of progressive onset within 15 days. It has appeared for 3 years a non-insulin-requiring diabetes treated with metformin. He drinks about 2 bottles of wine a day. The patient always takes esomeprazole 40 mg daily and an IM injection of vitamin 812 every month. No control endoscopy was performed. The biological assessment shows: Leukocyles at 7700\/mm3, neutrophils at 3200\/mm3, polynuclear eosinophils at 200\/mm3, lymphocytes at 3500\/mm3, hemoglobin at 9.3 g\/dL, MCV at 82 μ3 platelets at 110 0OO\/mm3, AST at 56 IU (N<40), ALT at 43 IU (N<40), TP at 54%, Total bilirubinemia at 87 μmol\/l. You perform an ascites puncture of which here are the results: proteins at 15g \/ L and elements: 500 \/ mm3 including 70% neutrophils, 20% lymphocytes, 10% monocytes. What diagnosis do you make?","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Peritoneal carcinomatosis"},{"idx":1,"correct":true,"proposition":"Ascites fluid infection on cirrhosis","justification":"Because PNN > 250\/mm3"},{"idx":2,"correct":false,"proposition":"Peritoneal tuberculosis"},{"idx":3,"correct":false,"proposition":"Rupture of a pancreatic pseudocyst","justification":""},{"idx":4,"correct":false,"proposition":"Rupture of hepatocellular carcinoma in the peritoneum","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-17-qi-8","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"You are diagnosed with ascites fluid infection. Which probabilistic antibiotic therapy(s) is\/are recommended as a first-line treatment? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Amoxicillin-clavulanic acid","justification":"Possible oral alternative"},{"idx":1,"correct":false,"proposition":"Vancomycin","justification":""},{"idx":2,"correct":false,"proposition":"Amikacin","justification":""},{"idx":3,"correct":false,"proposition":"Erythromycin","justification":""},{"idx":3,"correct":true,"proposition":"Cefotaxime","justification":"In the first intention"}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-17-qi-9","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"How will you confirm the diagnosis of cirrhosis with certainty in this patient? (one or more correct answers) ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Non-invasive fibrosis test","justification":""},{"idx":1,"correct":true,"proposition":"Hepatic ultrasound","justification":""},{"idx":2,"correct":false,"proposition":"Liver biopsy under ultrasound control","justification":"Contraindicated by ascites"},{"idx":3,"correct":true,"proposition":"Transjugular liver biopsy","justification":"Confirmatory diagnosis of cirrhosis is histological"},{"idx":4,"correct":false,"proposition":"Liver CT scan","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-17-qi-10","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"As part of the screening for viral hepatitis, what test(s) do you perform on this patient?","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Serology of viral hepatitis A","justification":""},{"idx":1,"correct":true,"proposition":"HBs antigen"},{"idx":2,"correct":true,"proposition":"Serology of viral hepatitis C (HCV)","justification":""},{"idx":3,"correct":false,"proposition":"Hepatitis B virus viral load","justification":""},{"idx":4,"correct":true,"proposition":"Hepatitis C virus viral load","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-17-qi-11","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"The evolution of the episode is favorable under antibiotics. The patient no longer has ascites. You set up a long-term follow-up. What measure(s) do you propose? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Screening for hepatocellular carcinoma","justification":""},{"idx":1,"correct":true,"proposition":"Screening for portal hypertension","justification":""},{"idx":2,"correct":true,"proposition":"Secondary prevention of ascites fluid infection","justification":""},{"idx":3,"correct":true,"proposition":"Screening for ENT cancers","justification":""},{"idx":4,"correct":true,"proposition":"Gastric cancer screening","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-17-qi-12","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"How do you screen for hepatocellular carcinoma (single response)? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Liver ultrasound every 6 months","justification":""},{"idx":1,"correct":false,"proposition":"Liver ultrasound every year","justification":""},{"idx":2,"correct":false,"proposition":"Liver CT scan every 6 months","justification":""},{"idx":3,"correct":false,"proposition":"Liver scan every year","justification":""},{"idx":4,"correct":false,"proposition":"Serum alpha-fetoprotein assay annually","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-17-qi-13","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"During follow-up, a 2 cm segment IV hepatic nodule is highlighted. You perform a CT scan to characterize it. What CT characteristic(s) are you looking for in favor of hepatocellular carcinoma? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Spontaneously hyperdense","justification":""},{"idx":1,"correct":true,"proposition":"Spontaneously hypodense","justification":""},{"idx":2,"correct":true,"proposition":"Contrast taking at arterial time","justification":""},{"idx":3,"correct":false,"proposition":"Hyperdensity at portal time","justification":"Hypodensity (washing, wash-out)"},{"idx":4,"correct":true,"proposition":"Hypodensity at portal time","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-17-qi-14","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"The CT scan reveals a spontaneously hypodense tumor, taking the contrast at arterial time and washing at portal time. The diagnosis of hepatocellular carcinoma is made. Which first-line treatment(s) will be discussed? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Hepatic resection","justification":""},{"idx":1,"correct":false,"proposition":"Intravenous chemotherapy","justification":""},{"idx":2,"correct":false,"proposition":"Intra-arterial chemotherapy","justification":""},{"idx":3,"correct":true,"proposition":"Percutaneous ablation","justification":"By radio frequency"},{"idx":4,"correct":false,"proposition":"External beam radiation therapy","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-17-qi-15","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"The patient is treated with radiofrequency. Two years later, his liver function deteriorated with the onset of refractory ascites. He also has a recurrence of his hepatocellular carcinoma as a new 3 cm nodule. He is 62 years old and you mention the possibility of a liver transplant. What are the prerequisites? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Effective alcohol withdrawal","justification":""},{"idx":1,"correct":false,"proposition":"Effective smoking cessation","justification":""},{"idx":2,"correct":true,"proposition":"Absence of extrahepatic cancer","justification":""},{"idx":3,"correct":true,"proposition":"Absence of extrahepatic metastasis of hepatocellular carcinoma","justification":""},{"idx":4,"correct":false,"proposition":"Absence of endoscopic portal hypertension","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-18-qi-1","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"Which of the following diagnoses can explain this picture? ","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Attention deficit disorder with or without hyperactivity","justification":""},{"idx":1,"correct":true,"proposition":"Characterized depressive episode","justification":""},{"idx":2,"correct":true,"proposition":"Hypochondria","justification":""},{"idx":3,"correct":false,"proposition":"Conversion hysteria","justification":""},{"idx":4,"correct":true,"proposition":"Persistent delusional disorder of somatic type","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-18-qi-2","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"At Mrs. B's insistence, the general practitioner finally agreed to prescribe a brain scan without injection. In the event of hypochondria (or excessive fear of having a disease), indicate the exact proposal(s). ","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The prescription of this examination may maintain the disorder","justification":""},{"idx":1,"correct":false,"proposition":"The normality of this examination will provide lasting reassurance to the patient.","justification":""},{"idx":2,"correct":false,"proposition":"The normality of this examination is necessary to confirm the diagnosis","justification":""},{"idx":3,"correct":false,"proposition":"An abnormality on this examination would rule out the diagnosis of hypochondria","justification":""},{"idx":4,"correct":true,"proposition":"The doctor-patient relationship may have influenced this prescribing decision","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-18-qi-3","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"The brain scan without injection performed during the week shows no abnormalities. Mrs. B consults the same doctor again and asks him to prescribe this examination again. She considers it to be << false results >> and explains that they want to make <<her look crazy but that they have not closed everything >>. Mrs. B states that she has a metal object in her brain following surgery. This object is not mentioned in the report of the scanner, so it would be according to her images of someone else. She wants to perform a new scanner in another radiology practice. We note in the words of Mrs. B.: ","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"A tendency to mythomania","justification":"The patient does not seem to be hiding the truth: she really believes what she says."},{"idx":1,"correct":true,"proposition":"Impaired judgment","justification":""},{"idx":2,"correct":false,"proposition":"Cenesthetic hallucinations","justification":""},{"idx":3,"correct":true,"proposition":"Delusions of persecution","justification":""},{"idx":4,"correct":false,"proposition":"Borderline personality traits","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-18-qi-4","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"The general practitioner having refused to prescribe a new scanner, Mrs. B decides to consult the same day at the emergency reception service (SAU) closest to her home. She refuses the nurse to take vital constants and threatens to commit suicide << like my father >> she says, if she is not examined by a neurosurgeon. When she is told that there is no neurosurgeon in the facility, Mrs. B gets up and walks to the exit without a word. Which of the following indicates a high suicidal risk in Mrs. B.?","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The presence of suicidal threats","justification":""},{"idx":1,"correct":true,"proposition":"The absence of relatives at his side","justification":""},{"idx":2,"correct":true,"proposition":"The presence of delusions","justification":""},{"idx":3,"correct":false,"proposition":"Taking estrogen-progestogens","justification":""},{"idx":4,"correct":true,"proposition":"His father's suicide","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-18-qi-5","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"The reception and orientation nurse tries to restrain Mrs. B but she threatens her with a pair of scissors that she has taken out of her bag. Which of the following is correct about physical restraint? ","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"It is justified by the immediate self-aggressive risk","justification":""},{"idx":1,"correct":true,"proposition":"It is justified by the immediate hetero-aggressive risk","justification":""},{"idx":2,"correct":false,"proposition":"It must be prescribed by a psychiatrist","justification":""},{"idx":3,"correct":false,"proposition":"She requires an admission measure in psychiatric care under duress","justification":""},{"idx":4,"correct":false,"proposition":"It must be declared secondarily to the liberty and detention judge","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-18-qi-6","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"Faced with self-threatening and hetero-aggressive threats, it is decided to resort to physical restraint. As the patient refuses any oral sedative treatment, an intramuscular injection of a sedative antipsychotic is prescribed. Which of the following considerations led to a preference for the class of antipsychotics over that of benzodiazepines in this case?","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Electrocardiogram not performed","justification":""},{"idx":1,"correct":true,"proposition":"Better intramuscular absorption","justification":""},{"idx":2,"correct":false,"proposition":"Better respiratory tolerance","justification":"It is true that they do not have respiratory adverse effects but this is not at all a consideration to take into account since the patient has no respiratory history."},{"idx":3,"correct":false,"proposition":"Young age","justification":""},{"idx":4,"correct":false,"proposition":"Lower risk of dependence","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-18-qi-7","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"Once Mrs. B is sedated, the physical restraint is lifted. The inventory of his belongings does not show any other dangerous object and makes it possible to find the report of the scanner. Upon awakening, psychiatric advice is sought. Mrs. B again exposes her conviction of having been deceived by the radiology office in front of the absence of metallic foreign body. She explains that << they are in cahoots with the intermeditators who point my thoughts... but I'm not going to obey them even if they mess me up... I'm not going to kill my mother... unless she's in them...I mean my mother is me actually... >>. We note in the words of Mrs. B.:","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Hermetic speech","justification":"Incomprehensible and several degrees above"},{"idx":1,"correct":true,"proposition":"Neologism","justification":"Intermediator"},{"idx":2,"correct":true,"proposition":"Paralogism","justification":""},{"idx":3,"correct":false,"proposition":"Dreamlike","justification":""},{"idx":4,"correct":true,"proposition":"Hallucinations","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-18-qi-8","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"Which of the following mental disorders could explain the entire clinical picture?","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Depressive episode with psychotic features","justification":"No symptoms of depression"},{"idx":1,"correct":true,"proposition":"Schizophrenia","justification":""},{"idx":2,"correct":false,"proposition":"Persistent delusional disorder","justification":""},{"idx":3,"correct":true,"proposition":"Encephalitis","justification":""},{"idx":4,"correct":false,"proposition":"Dissociative disorders","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-18-qi-9","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"The patient agrees to provide contact information for her mother who goes to the emergency room. She is received alone and then with her daughter who is told of the need for psychiatric hospitalization in another institution. The patient is reluctant to hospitalize in psychiatry but would accept to be hospitalized for << extraction of intermeditation electrodes >>. What orientation(s) do you recommend?","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Admission to voluntary psychiatric care","justification":""},{"idx":1,"correct":true,"proposition":"Admission to Conventional Third Party Psychiatric Care (PTDC)","justification":""},{"idx":2,"correct":false,"proposition":"Admission to Psychiatric Care at the Request of a Third Party in Emergency (UTDPS)","justification":""},{"idx":3,"correct":false,"proposition":"Admission to psychiatric care for imminent peril (SPPI)","justification":""},{"idx":4,"correct":false,"proposition":"Admission to psychiatric care by decision of the representative of the state (SPDRE)","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-18-qi-10","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"The anamnesis is completed in the psychiatric ward where Mrs. B was hospitalized at the request of a third party. Mrs. B, who lives with her mother, has been complaining of trouble concentrating and paying attention for more than a year and has sometimes been soliloquizing for at least six months. She no longer goes out and has gradually abandoned her usual activities, especially social ones. Unemployed after the non-renewal of a COD, she has not taken any steps to find work. The diagnosis of schizophrenia is made and pharmacological treatment is indicated. Which of the following should be part of the pre-therapeutic assessment:","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Blood pressure measurement","justification":""},{"idx":1,"correct":true,"proposition":"Blood glucose measurement","justification":""},{"idx":2,"correct":true,"proposition":"Lipid profile","justification":""},{"idx":3,"correct":false,"proposition":"Proteinuria","justification":""},{"idx":4,"correct":false,"proposition":"Electroencephalogram","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-18-qi-11","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"The pre-therapeutic assessment performed shows no abnormality and Mrs. B is not pregnant. Treatment with oral risperidone is started. After 4 weeks of treatment, neurological examination now shows a marked tremor of the extremities and a bilateral and symmetrical cogwheel. Mrs. B is less vehement but remains determined to obtain the surgical extraction of the device that she believes would have been implanted to manipulate it. Which of the following hypotheses could explain the persistence of positive symptoms? ","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Absence of associated psychotherapy","justification":"This cannot be a cause of persistence of hallucinations."},{"idx":1,"correct":false,"proposition":"Lack of actual treatment","justification":"The patient is hospitalized and the actual intake of treatments is monitored."},{"idx":2,"correct":true,"proposition":"Hidden cannabis intake","justification":""},{"idx":3,"correct":true,"proposition":"Comorbid neurological disorder","justification":""},{"idx":4,"correct":false,"proposition":"Partial dopaminergic agonist properties of the molecule","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-18-qi-12","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"The same treatment is continued for 4 more weeks. Mrs. B continues to report a manipulation of her thoughts but no longer plans to resort to surgery and recognizes that the treatment does her good. The discourse and thought remain disorganized but the first home leaves went well and a release is envisaged. Faced with the persistence of cognitive complaints about attention and concentration, a neuropsychological assessment is carried out which shows a marked alteration of executive functions. To what can you attribute this objective alteration? ","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Schizophrenic disorder","justification":""},{"idx":1,"correct":true,"proposition":"To an unknown addictive comorbidity","justification":""},{"idx":2,"correct":false,"proposition":"Iatrogenic hyperprolactinemia","justification":""},{"idx":3,"correct":false,"proposition":"The stress of hospitalization","justification":""},{"idx":4,"correct":false,"proposition":"Extrapyramidal syndrome","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-18-qi-13","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"Given the persistence of hallucina1ions and disorganization after several months of treatment, it was decided to replace risperidone with another atypical antipsychotic. After 3 months of treatment with olazanpine at optimal dosage, Mrs. B's disorders remain very disabling. You decide to change the antipsychotic treatment again. Which of the following options should be considered first? ","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Replacement with aripiprazole","justification":""},{"idx":1,"correct":true,"proposition":"Replacement with clozapine","justification":""},{"idx":2,"correct":false,"proposition":"Replacement with a typical antipsychotic","justification":""},{"idx":3,"correct":false,"proposition":"Potentiation by the addition of a typical antipsychotic","justification":""},{"idx":4,"correct":false,"proposition":"Potentiation by the addition of a thymoregulator","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-18-qi-14","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"Which of the following is an advantage(s) of clozapine therapy in this patient ","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Superior efficacy to other antipsychotics in treatment resistance","justification":""},{"idx":1,"correct":false,"proposition":"Lower risk of inducing metabolic syndrome","justification":"The risk is increased"},{"idx":2,"correct":true,"proposition":"Lower risk of extrapyramidal side effects","justification":""},{"idx":3,"correct":true,"proposition":"Reducing the risk of suicide","justification":""},{"idx":4,"correct":false,"proposition":"Possibility of resorting to a delayed form in case of poor compliance","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2018-dp-18-qi-15","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"The symptomatology improves markedly with clozapine until Mrs. B considers working again. Which of the following measures can (which) specifically promote this project?","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Cognitive remediation","justification":""},{"idx":1,"correct":true,"proposition":"Application for recognition of the status of disabled worker","justification":""},{"idx":2,"correct":false,"proposition":"Application for guardianship","justification":""},{"idx":3,"correct":true,"proposition":"Use of an Establishment and Work Assistance Service","justification":""},{"idx":4,"correct":false,"proposition":"Search for a home of life","justification":""}],"ts":{"$numberLong":"1665228551792"},"type":"dp"}
-{"_id":"annales-2019-dp-1-qi-1","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"Among the risks associated with this trip, what are the 2 potentially most serious? ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Turista (traveller's diarrhea)","justification":""},{"idx":1,"correct":true,"proposition":"Traffic accidents","justification":"Accidents in the broad sense are the leading cause of death when travelling abroad"},{"idx":2,"correct":false,"proposition":"Dengue fever","justification":""},{"idx":3,"correct":false,"proposition":"Rickettsiosis","justification":""},{"idx":4,"correct":true,"proposition":"Malaria","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-1-qi-2","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"What is (are) the possible preventive attitude(s) for this stay vis-à-vis the malaria risk? ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"No chemoprophylaxis","justification":""},{"idx":1,"correct":true,"proposition":"Atovaquone-proguanil chemoprophylaxis","justification":"Daily intake from the first day + one week after return"},{"idx":2,"correct":false,"proposition":"Mefloquine chemoprophylaxis","justification":"She has a psychiatric history, which contraindicates mefloquine"},{"idx":3,"correct":true,"proposition":"Doxycycline chemoprophylaxis","justification":""},{"idx":4,"correct":false,"proposition":"Chloroquine-proguanil chemoprophylaxis","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-1-qi-3","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"What information(s) do you give him about the yellow fever vaccine?","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Vaccine done in an approved center","justification":""},{"idx":1,"correct":true,"proposition":"Vaccine to be recorded on a WHO-approved international immunization record","justification":""},{"idx":2,"correct":false,"proposition":"Vaccine valid for 10 years","justification":""},{"idx":3,"correct":true,"proposition":"Live attenuated virus vaccine","justification":""},{"idx":4,"correct":false,"proposition":"Vaccine that should not be given on the same day as typhoid vaccine","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-1-qi-4","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"The patient travels to Côte d'Ivoire 🇨🇮 with antimalarial chemoprophylaxis with doxycycline. What should she remember as information about taking this medicine? (one or more answers are true) ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Daily intake","justification":""},{"idx":1,"correct":false,"proposition":"To start 1 month before departure","justification":"From the first day of departure"},{"idx":2,"correct":false,"proposition":"To be stopped on the day of return to France","justification":""},{"idx":3,"correct":true,"proposition":"To be stopped if pregnancy occurs","justification":""},{"idx":4,"correct":false,"proposition":"Must be combined with mefloquine due to prolonged stay","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-1-qi-5","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"Three months later, on the day of her return to France, the patient comes to your office because, for 2 days, she has not felt well and has pollakiuria with urination burns. During your discussion, she tells you that she had abdominal pain and diarrhea for a few days a little more than a month before her return that led her to stop doxycycline, thinking that this drug was the cause. Which of the following clinical signs is the most important to collect when deciding what to do? ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Number of urination per day","justification":""},{"idx":1,"correct":false,"proposition":"Blood in urine","justification":""},{"idx":2,"correct":false,"proposition":"Existence of urgency","justification":""},{"idx":3,"correct":false,"proposition":"Date of last urinary tract infection","justification":""},{"idx":4,"correct":true,"proposition":"Presence of fever","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-1-qi-6","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"The patient is not febrile and you are moving towards simple cystitis. The urine strip is positive. At this stage, what is the most relevant complementary examination? B. Search for ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"CRP","justification":""},{"idx":1,"correct":false,"proposition":"Chlamydia search","justification":""},{"idx":2,"correct":false,"proposition":"ECBU","justification":"Simple cystitis does not require ECBU (unlike cystitis at risk of complications)"},{"idx":3,"correct":true,"proposition":"No exam","justification":""},{"idx":4,"correct":false,"proposition":"NFS","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-1-qi-7","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"You do not carry out any additional examination. Which of the following treatment options will you choose as a first-line treatment for this patient? ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Fosfomycin-trometamol single dose","justification":""},{"idx":1,"correct":false,"proposition":"Ofloxacin single dose","justification":""},{"idx":2,"correct":false,"proposition":"Ciprofloxacin 5 days","justification":""},{"idx":3,"correct":false,"proposition":"Pivmecillinam 5 days","justification":""},{"idx":4,"correct":false,"proposition":"Nitrofurantoin 5 days","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-1-qi-8","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"What other recommendation(s) do you make? ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Do a follow-up ECBU in 72 hours (3 days)","justification":""},{"idx":1,"correct":true,"proposition":"Drink and urinate regularly","justification":""},{"idx":2,"correct":false,"proposition":"Take cranberry juice daily","justification":"This advice is relevant in case of recurrent cystitis (we are in the case of simple cystitis)"},{"idx":3,"correct":false,"proposition":"Do a vesicorenal ultrasound at a distance from the current episode","justification":""},{"idx":4,"correct":false,"proposition":"Abstaining from sex for 10 days","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-1-qi-9","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"Ten days later, the patient returns to your office with her partner. She tells you that the urinary signs disappeared 2 days after the treatment but that, for 4 days, she had several outbreaks of high fever with chills and sweats. She complains of stubborn headaches, nausea and abdominal pain with loose stools. The patient is apyretic, her clinical examination is normal, there is in particular no meningeal syndrome. Which of the following diagnoses should you mention first in this patient? ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Malaria","justification":""},{"idx":1,"correct":false,"proposition":"Acute pyelonephritis","justification":""},{"idx":2,"correct":false,"proposition":"Dengue fever","justification":""},{"idx":3,"correct":false,"proposition":"Typhoid fever","justification":""},{"idx":4,"correct":false,"proposition":"Chikungunya","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-1-qi-10","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"Which of the following clinical elements supports the diagnosis of malaria in this patient? ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"3 months stay in Ivory Coast","justification":""},{"idx":1,"correct":true,"proposition":"Digestive disorders","justification":""},{"idx":2,"correct":false,"proposition":"Cystitis preceding this febrile episode","justification":"There is no link between cystitis and malaria"},{"idx":3,"correct":true,"proposition":"Discontinuation of doxycycline 1 month before returning to France","justification":""},{"idx":4,"correct":true,"proposition":"Fever progressing in peaks","justification":"Periodic\/intermittent fever is common in malaria."}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-1-qi-11","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"You urgently carry out a check-up on this patient, the results of which are as follows. Which one(s) is the most suggestive of malaria diagnosis? ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Hemoglobin: 10.8 g\/dL","justification":""},{"idx":1,"correct":true,"proposition":"Blisters: 45 g\/L","justification":""},{"idx":2,"correct":false,"proposition":"CRP to 95","justification":""},{"idx":3,"correct":false,"proposition":"ALAT to 1.2","justification":""},{"idx":4,"correct":false,"proposition":"Kalemia at 3.3 mmol\/L","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-1-qi-12","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"Which exam(s) will allow you to make the diagnosis of malaria now? ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Blood","justification":""},{"idx":1,"correct":false,"proposition":"Malaria blood serology","justification":""},{"idx":2,"correct":true,"proposition":"Rapid test for HRP2 antigen","justification":""},{"idx":3,"correct":true,"proposition":"Blood smear","justification":""},{"idx":4,"correct":false,"proposition":"Procalcitonin","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-1-qi-13","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"The blood smear is 0.5% positive for Plasmodium falciparum. The patient does not vomit and wishes to go home. What first-line care do you offer her knowing that she is not pregnant? ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Quinine","justification":""},{"idx":1,"correct":false,"proposition":"Atovaquone + proguanil","justification":""},{"idx":2,"correct":true,"proposition":"Artenimol-piperaquine","justification":""},{"idx":3,"correct":true,"proposition":"Artemether-lumefantrine","justification":""},{"idx":4,"correct":false,"proposition":"Outpatient treatment","justification":"Her platelets are less than 50 G \/ L (question 11) so she has a hospitalization criterion. The statement is misleading because the patient's wish is always important and it is he who has the last word (we can not force this patient to be hospitalized), but the question is specifically about \"what we offer her\": we offer her hospitalization."}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-1-qi-14","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"You cannot treat this patient on an outpatient basis. Why (one or more possible answers)? ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"CRP 95 mg\/L","justification":""},{"idx":1,"correct":false,"proposition":"0.5% parasitemia","justification":""},{"idx":2,"correct":true,"proposition":"45 G\/L blisters","justification":""},{"idx":3,"correct":false,"proposition":"Haemoglobin at 10.8 g\/dL","justification":""},{"idx":4,"correct":false,"proposition":"Treatment with artenimol-piperaquine","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-1-qi-15","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"After 3 days of hospitalization, the patient is apyretic with a negative thick drip smear and can be discharged. At what time(s) do you organise biological controls?","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"On the 5th day of the start of treatment"},{"idx":1,"correct":true,"proposition":"On the 7th day of the start of treatment","justification":"J3, J7, J28 😊 . It fell twice, so that's to know."},{"idx":2,"correct":false,"proposition":"On day 14 of the start of treatment"},{"idx":3,"correct":false,"proposition":"On the 21st day of the start of treatment"},{"idx":4,"correct":true,"proposition":"On the 28th day of the start of treatment"}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-3-qi-1","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"Which clinical sign(s) would direct you to Pancoast-Tobias syndrome? Give the correct answer(s).","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"An alteration of the general condition","justification":""},{"idx":1,"correct":true,"proposition":"A deficit of the interosseous muscles of the hand","justification":"There are 4 palmar interosseous and 4 dorsal interosseous. They are innervated by the C8 Th1 ulnar nerve, which is affected in Pancoast-Tobias syndrome."},{"idx":2,"correct":false,"proposition":"Diplopia","justification":"It is a symptom found in alternating syndromes for example"},{"idx":3,"correct":false,"proposition":"Irradiation of pain in the thumb","justification":"The ulnar nerve innervates the fifth finger and medial half of the fourth."},{"idx":4,"correct":true,"proposition":"The association a ptosis","justification":"Ptosis - Myosis - Enophtalmos is part of another syndrome 😉"}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-3-qi-2","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"The patient does not have an impairment in the general condition. Which of the following signs is the one that points to a joint cause of pain? Give the correct answer(s).","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Limiting passive lateral rotation","justification":""},{"idx":1,"correct":false,"proposition":"Localization of pain on the anterior side of the shoulder","justification":""},{"idx":2,"correct":false,"proposition":"Worsening pain in abduction","justification":""},{"idx":3,"correct":true,"proposition":"Presence of joint effusion","justification":"Joint effusion is often a sign of a local inflammatory cause"},{"idx":4,"correct":false,"proposition":"Pain on palpation of the delto-pectoral sulcus","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-3-qi-3","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"Which of these muscles is (are) part of the rotator cuff? Give the correct answer(s).","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"The supraspinatus tendon","justification":""},{"idx":1,"correct":false,"proposition":"The large round tendon","justification":"The little circle is one of them. Unfortunately, you have to learn these muscles - this question often falls, whether in IQ or PD."},{"idx":2,"correct":false,"proposition":"The tendon of the deltoid","justification":""},{"idx":3,"correct":true,"proposition":"Subscapularis tendon","justification":""},{"idx":4,"correct":true,"proposition":"The infraspinatus tendon ","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-3-qi-4","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"The clinical examination reveals an active abduction of normal but painful amplitude of the shoulder. There is a painful arc with active abduction pain between 60 ° and 120 °. The lateral rotation is of normal and symmetrical amplitude. The passive elevation of the upper limb in internal rotation and antepulsion is painful. The following clinical maneuver is painful while other cuff muscle tensioning maneuvers are painless. Which tendon is responsible?","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"The supraspinatus tendon","justification":"This is Jobe's maneuver"},{"idx":1,"correct":false,"proposition":"The large round tendon","justification":""},{"idx":2,"correct":false,"proposition":"The tendon of the deltoid","justification":""},{"idx":3,"correct":false,"proposition":"Subscapularis tendon","justification":""},{"idx":4,"correct":false,"proposition":"The infraspinatus tendon ","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-3-qi-5","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"You do a standard X-ray to the patient (below). Which of these proposals is the exact answer(s)? Give the correct answer(s).","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"There is a decrease in the height of the space under acromial","justification":""},{"idx":1,"correct":false,"proposition":"There is osteoarthritis","justification":""},{"idx":2,"correct":false,"proposition":"There is calcification of the rotator cuff tendons","justification":""},{"idx":3,"correct":true,"proposition":"X-ray is normal","justification":""},{"idx":4,"correct":false,"proposition":"There is osteolysis of the major tubercle","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-3-qi-6","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"At this stage of management, which additional imaging test(s) of the right shoulder can you request? Give the correct answer(s).","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Scanner","justification":""},{"idx":1,"correct":true,"proposition":"MRI","justification":"MRI and ultrasound are the two tests that directly visualize the tendons."},{"idx":2,"correct":false,"proposition":"Arthro-MRI","justification":""},{"idx":3,"correct":false,"proposition":"Arthroscanner","justification":""},{"idx":4,"correct":true,"proposition":"Echography","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-3-qi-7","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"The sonographer answers that it is an unruptured tendinopathy of the supraspinatus. You prescribe shoulder rehabilitation. In this patient, what is(are) the objective(s) of physiotherapy? Give the correct answer(s).","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Strengthen the deltoid","justification":""},{"idx":1,"correct":true,"proposition":"Strengthen the latissimus dorsi","justification":""},{"idx":2,"correct":false,"proposition":"Increase passive range of motion","justification":"The question insists on 'this patient' who does not have passive range of motion."},{"idx":3,"correct":true,"proposition":"Reduce pain","justification":""},{"idx":4,"correct":true,"proposition":"Provide educational advice","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-3-qi-8","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"After a month and 15 sessions of physiotherapy, the patient is still as painful when raising the shoulder. Which strategy(s) is relevant? Give the correct answer(s).","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"You check if the patient is observant","justification":""},{"idx":1,"correct":true,"proposition":"You check the tolerance of the sessions","justification":""},{"idx":2,"correct":true,"proposition":"You strengthen analgesic care","justification":""},{"idx":3,"correct":false,"proposition":"You request a shoulder scan","justification":"The CT scan is not very useful for the study of tendons, MRI is preferred."},{"idx":4,"correct":true,"proposition":"You check your differential diagnoses","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-3-qi-9","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"The patient was able to return to work. Trying to catch up with a slide on a scaffolding, he has complete functional impotence of the right upper limb. Here is the front X-ray of the right shoulder. What element(s) does it bring you? Give the correct answer(s).","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"There is a fracture of the surgical cervix of the humerus","justification":""},{"idx":1,"correct":true,"proposition":"There is an anteroinferior glenohumeral dislocation","justification":""},{"idx":2,"correct":false,"proposition":"There is an acromioclavicular disjunction","justification":""},{"idx":3,"correct":false,"proposition":"There is a fracture of a displaced rib","justification":""},{"idx":4,"correct":false,"proposition":"There is a notch of Malgaigne","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-3-qi-10","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"Before proceeding to reduce this dislocation, you examine the sensitivity of the stump of the shoulder. An isolated abnormality at this level is in favor of nerve damage: ","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"axillary","justification":""},{"idx":1,"correct":false,"proposition":"supraspinatus","justification":""},{"idx":2,"correct":false,"proposition":"long thoracic","justification":""},{"idx":3,"correct":false,"proposition":"radial","justification":""},{"idx":4,"correct":false,"proposition":"musculocutaneous","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-3-qi-11","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"The patient did not have associated nerve damage prior to external manoeuvring reduction of the glenohumeral joint. The review of awareness after reduction is not changed. You set up an immobiliatlon by an elbow brace to the body. You see the patient again a month later. On clinical examination, you notice the following: passive mobility is not diminished, the right arm in anterior elevation and internal rotation, the patient can not resist the force of abbaissement that you exert, when he wants to bring his hand to the mouth, you observe that the patient is forced to raise his elbow laterally above the level of his hand. In addition, the arm placed in external rotation elbows to the body, there is an automatic internal rotation. Passive external rotation is not increased. The patient retains the possibility of taking off the hand placed in the back at the lumbosacral junction. There is no abnormality during thwarted active flexion of the elbow when the palms are up. Given the data of the clinical examination, you mention the possibility of a rupture of one or more of the following elements: (one or more true propositions)","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Supraspinatus","justification":""},{"idx":1,"correct":false,"proposition":"Pectoralis Major","justification":""},{"idx":2,"correct":true,"proposition":"Infraspinatus","justification":""},{"idx":3,"correct":true,"proposition":"Teres minor (small round)","justification":""},{"idx":4,"correct":false,"proposition":"Subscapular","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-3-qi-12","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"Given the functional discomfort, rotator cuff repair surgery is offered to the patient. While waiting for the consultation of the anaesthetist, the patient asks you a few questions. Which of the following answers you could give is correct? ","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"For this scheduled procedure, the anesthesia consultation can take place until the day before the intervention","justification":""},{"idx":1,"correct":false,"proposition":"You will see either a doctor or a nurse anaesthetist for this consultation","justification":""},{"idx":2,"correct":true,"proposition":"You will not necessarily have to take a blood test before the procedure","justification":""},{"idx":3,"correct":true,"proposition":"If you do not wish to have locoregional anesthesia, you can refuse it","justification":"It is always the patient who decides!"},{"idx":4,"correct":false,"proposition":"As you are taking aspirin for the heart, it will in any case be necessary to stop it between 5 and 7 days before the procedure","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-3-qi-13","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"The patient is now in the post-interventional monitoring room following his surgery, which took place without incident anesthetic and surgically. He expresses pain at 8 out of 10 on the numerical scale and asks to be relieved. Which multimodal analgesia(s) are indicated in this context, among the analgesia represented in the figure below? PCA: patient-controlled analgesia (or PDA) ","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Has","justification":""},{"idx":1,"correct":false,"proposition":"B","justification":""},{"idx":0,"correct":false,"proposition":"C","justification":""},{"idx":1,"correct":false,"proposition":"D","justification":""},{"idx":0,"correct":true,"proposition":"E","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-3-qi-14","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"Morphine titration was initiated because it was severe pain. It was relayed by patient-controlled analgesia (PCA) with paracetamol and nefopam as part of multimodal postoperative analgesia. It has been effective. The ACP was arrested on the second day. On the third day, the patient again complains of pain, the intensity of which is measured at 54 mm on a visual analogue scale, and he wishes to be relieved. His current analgesic treatment includes paracetamol and nefopam. Which treatment(s) is (are) indicated in the context of multimodal analgesia in this context? ","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Tramadol","justification":""},{"idx":1,"correct":false,"proposition":"Ketoprofen (NSAIDs)","justification":""},{"idx":2,"correct":false,"proposition":"Oxycodone","justification":""},{"idx":3,"correct":false,"proposition":"Transcutaneous electrical nerve stimulation (TENS)","justification":""},{"idx":4,"correct":true,"proposition":"Application of refrigeration","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-3-qi-15","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"After 5 months of rehabilitation, the patient has regained satisfactory active and passive mobility and he hardly complains of pain. He questions you about the resumption of his work because he fears that he will not be able to continue his activity. In agreement with your patient, you wish to contact his occupational physician. Which element(s) is (are) relevant to transmit to the occupational physician? ","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"None, so as not to break medical confidentiality","justification":""},{"idx":1,"correct":true,"proposition":"Functional sequelae on the shoulder","justification":""},{"idx":2,"correct":true,"proposition":"The initial lesion assessment","justification":""},{"idx":3,"correct":false,"proposition":"A certificate of aptitude for his position","justification":""},{"idx":4,"correct":true,"proposition":"Possible extra-occupational risk factors","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-5-qi-1","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"Which of the following clinical elements is present in the observation?","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Spatial disorientation","justification":"'She thinks she is at home'"},{"idx":1,"correct":true,"proposition":"Zoopsies","justification":"'Scaring away cockroaches' 🐾"},{"idx":2,"correct":true,"proposition":"Disturbance of attention","justification":"'You have to repeat it several times because it seems elsewhere'"},{"idx":3,"correct":false,"proposition":"Tachypsychia","justification":""},{"idx":4,"correct":false,"proposition":"Mental automatism","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-5-qi-2","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"Faced with this state of agitation, which of the following elements present in the observation, which one (directs) towards a delirium rather than an acute psychotic state?","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Spatial disorientation","justification":""},{"idx":1,"correct":false,"proposition":"Delusions of persecution","justification":"These are characteristic of the LFS"},{"idx":2,"correct":true,"proposition":"Abrupt onset in a post-operative context","justification":"The postoperative context points much more towards confusion (known link between confusion and surgery) than towards EPA (no known link between EPA and surgery)"},{"idx":3,"correct":false,"proposition":"Major anxiety","justification":"Anxiety is found in both etiologies. This is a characteristic of agitation."},{"idx":4,"correct":true,"proposition":"Fluctuation of symptoms","justification":"The EPA does not fluctuate, or does not fluctuate, or little"}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-5-qi-3","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"Which of the following clinical elements would be in favor of delirium syndrome?","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Time disorientation","justification":"This is characteristic"},{"idx":1,"correct":true,"proposition":"Hyperthermia","justification":"This can be a confusing trigger"},{"idx":2,"correct":true,"proposition":"Predominance of visual hallucinations","justification":"Visual (rather than auditory) hallucinations are often found in confusion."},{"idx":3,"correct":false,"proposition":"Psychiatric history","justification":""},{"idx":4,"correct":true,"proposition":"Reversal of the nycthemeral rhythm","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-5-qi-4","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"The agitation is fluctuating but she does not repeat her hetero-aggressive threats and agrees to be escorted back to her room. She remains disoriented in space and time. At this stage, which of the following additional examinations is essential to carry out immediately? ","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Alcohol","justification":""},{"idx":1,"correct":false,"proposition":"Search for urinary toxicants","justification":""},{"idx":2,"correct":true,"proposition":"Capillary blood glucose","justification":"Any acute and non-systematized neurological signs should be investigated for hypoglycemia as a first-line treatment."},{"idx":3,"correct":false,"proposition":"Injected brain scan","justification":""},{"idx":4,"correct":false,"proposition":"Blood ionogram","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-5-qi-5","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"Capillary blood glucose is 3.8 mmol\/L. Which of the following causes should be mentioned in front of the clinical picture presented by the patient? ","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Alcohol withdrawal","justification":""},{"idx":1,"correct":true,"proposition":"Adverse effects of opioid analgesics","justification":""},{"idx":2,"correct":false,"proposition":"Hypoglycaemia","justification":"Blood sugar is normal"},{"idx":3,"correct":true,"proposition":"Subacute subdural hematoma","justification":""},{"idx":4,"correct":true,"proposition":"Hyponatremia","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-5-qi-6","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"Physical examination shows sweating, tachycardia and tremor of extremities. The neurological examination cannot be continued due to increased agitation. The patient nevertheless accepts oral treatment. What do you recommend? ","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Benzodiazepine therapy","justification":"We start on an alcoholic withdrawal in view of the clinical description and the context of the patient."},{"idx":1,"correct":false,"proposition":"Treatment with sedative neuroleptic","justification":""},{"idx":2,"correct":true,"proposition":"Brain scan without injection as soon as possible","justification":""},{"idx":3,"correct":true,"proposition":"Constant behavioural monitoring","justification":""},{"idx":4,"correct":false,"proposition":"Request for psychiatric opinion","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-5-qi-7","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"Given the delirium syndrome and the context of fall with scalp wound, a brain scan is prescribed urgently after benzodiazepine sedation. The brain scan is normal but biology shows a moderate elevation of gamma-glutamyl-transpeptidase (GGT) and transaminases (predominant on AST) contrasting with a normal level of alkaline phosphatase, as well as an elevation of mean corpuscular volume. The blood ionogram and serum calcium are normal. CPKs are quietly increased. The temperature is 37.8 °C.  The patient is no longer agitated but still disoriented, anxious and continues to make delusional remarks. What do you recommend in the immediate future? (one or more responses) ","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Thiamine","justification":""},{"idx":1,"correct":true,"proposition":"Hydration","justification":""},{"idx":2,"correct":false,"proposition":"Valproic acid","justification":""},{"idx":3,"correct":false,"proposition":"Physical restraint","justification":"The patient is no longer agitated"},{"idx":4,"correct":false,"proposition":"Antipsychotic","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-5-qi-8","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"You have set up intravenous hydration treatment and administration of vitamin B1 and Diazepam. Which of the following clinical and biological elements is part of the monitoring of delirium tremens?","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Blood pressure"},{"idx":1,"correct":true,"proposition":"Heart rate"},{"idx":2,"correct":true,"proposition":"Temperature","justification":"The patient is subfebrile. The normalization of its temperature is monitored. This parameter is not part of the Cushman score (but it is still checked in the delirium tremens) 😉"},{"idx":3,"correct":false,"proposition":"Haemoglobin"},{"idx":4,"correct":false,"proposition":"Gamma-glutamyl-transpeptidase","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-5-qi-9","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"The evolution of delirium is favorable in a few days and an addictological consultation is organized. The patient reports excessive daily alcohol consumption but says she has not lost control of her consumption and does not need addiction management. Which of the following attitudes you could adopt to promote patient adherence, which are specifically motivational interviewing techniques? ","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Explain the link between alcohol consumption and delirium tremens episode","justification":""},{"idx":1,"correct":false,"proposition":"Explain other risks associated with alcohol consumption","justification":""},{"idx":2,"correct":true,"proposition":"Ask the patient what her alcohol consumption brings","justification":""},{"idx":3,"correct":true,"proposition":"Talk about ambivalence to change as normal","justification":""},{"idx":4,"correct":false,"proposition":"Introduce drug treatments to help maintain abstinence","justification":"Motivational interviewing meets a very specific definition."}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-5-qi-10","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"The patient is followed by her general practitioner with a goal of complete abstinence. However, she was unable to stop drinking for more than five days. Which of the following classes of drugs can be prescribed as an aid to maintain abstinence? ","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"A selective serotonin reuptake inhibitor","justification":""},{"idx":1,"correct":false,"proposition":"A benzodiazepine","justification":""},{"idx":2,"correct":true,"proposition":"An opioid antagonist","justification":""},{"idx":3,"correct":false,"proposition":"A thymoregulator","justification":""},{"idx":4,"correct":false,"proposition":"An anticonvulsant","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-5-qi-11","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"Management by the general practitioner continues, but without a significant reduction in alcohol consumption. She continues to drink one and a half bottles of wine a day. The patient often comes to the consultations having been drinking. She then cries a lot, says she is sad, lacking appetite and blaming herself. What therapeutic strategy(s) is (are) indicated for this patient? ","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":" Outpatient care in an addiction center","justification":""},{"idx":1,"correct":false,"proposition":"Emergency psychiatric hospitalization","justification":""},{"idx":2,"correct":false,"proposition":"Prescribing an antidepressant","justification":"The description does not meet the DSM-5 criteria for depression."},{"idx":3,"correct":true,"proposition":"Cognitive Behavioural Therapy","justification":""},{"idx":4,"correct":true,"proposition":"Scheduled hospitalization for alcohol withdrawal","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-5-qi-12","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"The patient is cared for in a CSAPA (center for care, support and prevention in addiction) and a scheduled withdrawal has made it possible to obtain complete abstinence from alcohol for 3 months. Despite this, she continues to suffer from a deep malaise and tells her doctor that she can no longer bear to live alone, that she feels tired in the morning and needs several hours to prepare. It is very difficult to make decisions, she is incompetent in all areas and has a strong tendency to eat between meals to the point of having gained 5 kilos for 2 months. In addition, she worries almost all day and excessively for various reasons and takes more than an hour before falling asleep. She goes out little and sees very few people because she dreads all the encounters and is afraid of not being up to it. What diagnostic criterion(s) of severe depression do you identify among the symptoms presented by this patient:","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Self-depreciation","justification":"Minor criterion"},{"idx":1,"correct":false,"proposition":"Feeling lonely","justification":"Feeling lonely is not a DSM-5 criterion. Wicked trap 🙈"},{"idx":2,"correct":true,"proposition":"Cognitive impairment","justification":"Minor criterion"},{"idx":3,"correct":true,"proposition":"Overeating","justification":"Minor criterion"},{"idx":4,"correct":true,"proposition":"Slowdown","justification":"Minor criterion"}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-5-qi-13","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"What other diagnosis(s) does the patient's clinical picture suggest? ","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Generalized anxiety disorder (GAD)","justification":""},{"idx":1,"correct":true,"proposition":"Social phobia","justification":""},{"idx":2,"correct":false,"proposition":"Agoraphobia","justification":""},{"idx":3,"correct":false,"proposition":"Syndrome de Korsakoff","justification":""},{"idx":4,"correct":false,"proposition":"Schizoid personality disorder","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-5-qi-14","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"A prescription of antidepressant monotherapy (escitalopram) was implemented 4 months ago and has achieved complete remission of the depressive episode for 3 months now. The patient remained abstinent in alcohol 🍷. However, she remains very anxious in many situations of everyday life. What therapeutic orientation(s) is (are) indicated at this stage?","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Gradual discontinuation of escitalopram","justification":""},{"idx":1,"correct":true,"proposition":"Cognitive Behavioural Therapy","justification":""},{"idx":2,"correct":false,"proposition":"EMDR","justification":""},{"idx":3,"correct":false,"proposition":"Beta-blocker","justification":""},{"idx":4,"correct":false,"proposition":"Sedating neuroleptic","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-5-qi-15","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"After 12 months of treatment with escitalopram and maintenance of a complete and stable remission of the depressive episode, what argument(s) can justify the extension of this long-term treatment? ","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Identification of a history of depressive episodes","justification":""},{"idx":1,"correct":false,"proposition":"Identification of a history of manic episode","justification":""},{"idx":2,"correct":false,"proposition":"Signs of drug withdrawal occurring when you forget to take","justification":"There is no withdrawal syndrome"},{"idx":3,"correct":true,"proposition":"Severe generalized anxiety disorder","justification":""},{"idx":4,"correct":false,"proposition":"Avoidant personality disorder","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-5-qi-16","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"The patient consults a year later. She has not taken an antidepressant for 6 months, but takes alprazolam in varying doses prescribed by another doctor every day. What therapeutic strategy(s) can be proposed to limit the risk of benzodiazepine dependence in this patient? ","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Information on the risks of chronic benzodiazepine use","justification":""},{"idx":1,"correct":true,"proposition":"Participation in a mutual aid group (GEM)","justification":"Doubt on this question: there is no mention of these GEM in the college 🤷 ♂️ But we decide to tick it just since it seems logical."},{"idx":2,"correct":false,"proposition":"Extension of the prescription of alprazolam at a stable dose to achieve complete remission","justification":""},{"idx":3,"correct":false,"proposition":"Replacement of alprazolam with a benzodiazepine with a shorter half-life","justification":"The shorter the half-life, the higher the risk."},{"idx":4,"correct":true,"proposition":"Information on non-drug therapeutic alternatives","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-6-qi-1","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"Regarding the confusion in this situation, what is(are) the exact answer(s)? (one or more true propositions)","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"It can persist for several days","justification":"This is called post-critical confusion, which lasts a few minutes to a few hours."},{"idx":1,"correct":false,"proposition":"It may be followed by persistent cognitive impairment","justification":""},{"idx":2,"correct":true,"proposition":"It is manifested by a spontaneous language disorder","justification":""},{"idx":3,"correct":true,"proposition":"Its association with temporospatial disorientation is constant","justification":""},{"idx":4,"correct":true,"proposition":"It is manifested in particular by behavioral disorders","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-6-qi-2","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"Regarding the mechanism of this loss of knowledge, what is (are) the right proposal(s)? (one or more true propositions)","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"You mention the diagnosis of tonic-clonic seizure because witnesses report convulsive movements"},{"idx":1,"correct":false,"proposition":"You retain the diagnosis of tonic-clonic seizure since the patient reported a loss of urine","justification":""},{"idx":2,"correct":false,"proposition":"The absence of tongue bite makes it possible to rule out the diagnosis of tonic-clonic seizure","justification":""},{"idx":3,"correct":false,"proposition":"The fact that the patient says she does not remember anything supports a psychogenic origin of the loss of consciousness","justification":""},{"idx":4,"correct":true,"proposition":"The existence of confusion during the management by the SAMU makes you evoke a tonic-clonic epileptic seizure","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-6-qi-3","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"What element(s) would be in favor of convulsive syncope? ","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Extreme pallor","justification":""},{"idx":1,"correct":true,"proposition":"Immediate resumption of normal consciousness","justification":""},{"idx":2,"correct":false,"proposition":"Duration of loss of consciousness of at least five minutes","justification":"Rather epilepsy"},{"idx":3,"correct":false,"proposition":"Clonic shaking of all four limbs","justification":"Not the four members 😉"},{"idx":4,"correct":false,"proposition":"Loss of urine","justification":"It is not discriminatory."}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-6-qi-4","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"During the interrogation, you learn that the patient is sometimes surprised in the morning by jolts of the upper limbs. She even suddenly dropped the cup of coffee she was holding as the movement was so abrupt. Regarding this symptom, you mention:  ","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Tetany","justification":""},{"idx":1,"correct":false,"proposition":"Tics","justification":""},{"idx":2,"correct":false,"proposition":"Physiological myoclonus","justification":""},{"idx":3,"correct":true,"proposition":"Epileptic myoclonus","justification":""},{"idx":4,"correct":false,"proposition":"Psychogenic manifestations","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-6-qi-5","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"You integrate this symptom into your syndromic reasoning. What is the exact proposal(s):","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"This symptom calls into question the diagnosis of an epileptic mechanism concerning the episode of loss of consciousness","justification":""},{"idx":1,"correct":false,"proposition":"This symptom associated with the clinical suspicion of tonic-clonic seizure is in favor of secondarily generalized partial epilepsy","justification":""},{"idx":2,"correct":true,"proposition":"This symptom associated with clinical suspicion of tonic-clonic seizure is in favor of idiopathic generalized epilepsy","justification":""},{"idx":3,"correct":false,"proposition":"This symptom requires psychiatric advice","justification":""},{"idx":4,"correct":true,"proposition":"This symptom should cause the interrogation to look for photosensitivity","justification":"Triggering at light exposure."}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-6-qi-6","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"You remember the existence of epileptic myoclonus. Regarding epileptic myoclonus, which is (are) the exact proposal(s)? ","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"They can be observed during generalized epilepsy","justification":""},{"idx":1,"correct":true,"proposition":"They can be observed during partial epilepsies","justification":""},{"idx":2,"correct":true,"proposition":"They are favored by lack of sleep","justification":""},{"idx":3,"correct":true,"proposition":"They are favored by intermittent light stimulation","justification":""},{"idx":4,"correct":false,"proposition":"They can occur in the absence of concomitant epileptic discharge on the electroencephalogram","justification":"It would be bad luck anyway 🤔"}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-6-qi-7","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"In the first hours of your care, which additional examination(s) for etiological purposes will you perform? ","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"A brain MRI","justification":"Not in the first hours but it is systematic in a second time."},{"idx":1,"correct":false,"proposition":"A lumbar puncture","justification":"The repetition of symptoms is not in favor of an infectious origin."},{"idx":2,"correct":true,"proposition":"An electroeneghalogram","justification":"We will look for a background 😉 activity"},{"idx":3,"correct":false,"proposition":"A search for toxicants in urine","justification":"The repetition of symptoms is not in favor."},{"idx":4,"correct":false,"proposition":"A brain angiography","justification":"We can consider a CT scan, but not a CT angiography (we do not think of ischemia in front of this table)."}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-6-qi-8","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"You have to perform an electroencephalogram one hour after admission. What characteristic(s) do you remember at the seventh second of the recording? ","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Generalized epileptic discharge"},{"idx":1,"correct":false,"proposition":"A physiological trace (normal rhythm)"},{"idx":2,"correct":false,"proposition":"Discharge characteristic of an absence"},{"idx":3,"correct":true,"proposition":"One landfill recorded on all leads (lines)"},{"idx":4,"correct":false,"proposition":"A discharge characteristic of a partial crisis"}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-6-qi-9","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"A brain MRI is performed remotely, what do you expect (indicate the exact proposal(s))? ","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"It will be normal in case of idiopathic generalized epilepsy","justification":""},{"idx":1,"correct":true,"proposition":"An MRI abnormality is not necessarily responsible for epilepsy","justification":""},{"idx":2,"correct":false,"proposition":"An MRI abnormality will prove that the patient's symptoms are epileptic","justification":""},{"idx":3,"correct":false,"proposition":"The absence of abnormalities on MRI will make it possible to reject the diagnosis of epilepsy in this patient","justification":""},{"idx":4,"correct":false,"proposition":"The presence of an abnormality on MRI will prove that epilepsy is of partial origin in this patient","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-6-qi-10","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"Brain MRI is normal. What is the diagnosis? ","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":" Rolandic paroxysmic epilepsy ","justification":""},{"idx":1,"correct":true,"proposition":"Benign juvenile myoclonic epilepsy","justification":""},{"idx":2,"correct":false,"proposition":" Temporal partial epilepsy","justification":""},{"idx":3,"correct":false,"proposition":" Cryptogenic epilepsy","justification":""},{"idx":4,"correct":false,"proposition":"Convulsive syncope","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-6-qi-11","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"You have retained the diagnosis of benign juvenile myoclonic epilepsy. You discuss with the patient the initiation of background antiepileptic therapy. What is the exact proposal(s)? ","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"There is no indication for background anti-epileptic treatment as she had only one generalized seizure","justification":""},{"idx":1,"correct":false,"proposition":"The benign nature of epilepsia justifies therapeutic abstention","justification":""},{"idx":2,"correct":true,"proposition":"The prescription of background anti-epileptic treatment must be accompanied by therapeutic education","justification":""},{"idx":3,"correct":false,"proposition":"Prescription of background antiepileptic therapy contraindicates oral contraception","justification":""},{"idx":4,"correct":true,"proposition":"The prescription must be maintained over the long term to prevent the recurrence of its pathology","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-6-qi-12","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"Treated for 18 months with lamotrigine, she has never reoffended. She wants to pass her driver's license. What is the exact answer(s) regarding driving? ","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Driving a public transit vehicle is definitely contraindicated","justification":""},{"idx":1,"correct":false,"proposition":"Driving a light vehicle is possible without restriction","justification":""},{"idx":2,"correct":true,"proposition":"The physician must inform the patient of the regulatory procedures","justification":""},{"idx":3,"correct":false,"proposition":"Driving will be possible with a certificate from the attending physician","justification":""},{"idx":4,"correct":false,"proposition":"Taking antiepileptic treatment prohibits driving","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-6-qi-13","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"She asks you about her contraception. What is the exact answer(s)? ","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Oral contraception is contraindicated","justification":""},{"idx":1,"correct":false,"proposition":"Lamotrigine is an enzyme inducer of estrogen-progestin contraceptives","justification":""},{"idx":2,"correct":false,"proposition":"You recommend stopping antiepileptic treatment","justification":""},{"idx":3,"correct":true,"proposition":"You authorize the contraception of his choice","justification":""},{"idx":4,"correct":false,"proposition":"You recommend a change in antiepileptic treatment","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-6-qi-14","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"Five years later, the patient expresses a desire for pregnancy and wishes to have information. What is the exact answer(s)? ","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Genetic counseling should be offered","justification":""},{"idx":1,"correct":false,"proposition":"The context of pregnancy makes you offer dual therapy","justification":""},{"idx":2,"correct":true,"proposition":"You set up folic acid supplementation","justification":""},{"idx":3,"correct":false,"proposition":"Close ultrasound monitoring will be necessary during the last trimester of pregnancy","justification":""},{"idx":4,"correct":false,"proposition":"Under treatment the risk of malformation is higher than that of the general population","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-7-qi-1","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"In the emergency room, the patient is taken care of. The clinical examination, supplemented by imaging, confirms a closed fracture of the right wrist requiring surgery. The wounds of the upper limbs are to be sutured. The caregiver washes his hands according to the following steps. Which of the following suggestions for standard hygiene precautions for performing sutures in emergency rooms is correct?","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Wearing a surgical mask for the operator is recommended","justification":""},{"idx":1,"correct":false,"proposition":"The friction of the hands in 6 steps with a hydro-alcoholic solution, before the treatment, is in accordance with the recommendations","justification":""},{"idx":2,"correct":false,"proposition":"The duration of hand rubbing should last at least one minute","justification":"30 seconds ⌛ (painful trap)"},{"idx":3,"correct":true,"proposition":"Wearing a pair of goggles is recommended","justification":""},{"idx":4,"correct":true,"proposition":"Gloves are required","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-7-qi-2","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"The wounds were sutured. You ask the patient about his vaccination status that he does not know. What modality(s) of prevention of the risk of infection do you implement?","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"You give him an injection of 250 IU of tetanus immunoglobulins in the emergency room","justification":""},{"idx":1,"correct":true,"proposition":"You give him an injection of a dose of vaccine containing tetanus valence in the emergency room","justification":""},{"idx":2,"correct":false,"proposition":"You start antibiotic therapy with amoxicillin and clavulanic acid for a period of 10 days","justification":""},{"idx":3,"correct":true,"proposition":"You are planning a tetanus vaccination booster for this patient","justification":""},{"idx":4,"correct":true,"proposition":"You are planning a new consultation for wound healing monitoring in a week 1 1","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-7-qi-3","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"You inform the patient of the need for surgery followed by hospitalization to treat their wrist fracture. The patient refuses surgery and hospitalization. Which of the following proposals regarding patient information and consent is accurate? ","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"The patient's low level of understanding of the French language exempts the physician from obtaining the patient's consent","justification":""},{"idx":1,"correct":true,"proposition":"The doctor must inform this patient of the expected benefits and possible risks of the surgical procedure","justification":""},{"idx":2,"correct":false,"proposition":"The status of illegal alien exempts the doctor from obtaining the patient's consent","justification":""},{"idx":3,"correct":true,"proposition":"The physician must ensure the patient's understanding by asking him to say what he has understood","justification":""},{"idx":4,"correct":true,"proposition":"The presence of the interpreter is recommended during the interview with the patient","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-7-qi-4","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"The exchange with the patient highlights that his refusal is mainly motivated by the cost of surgery and hospitalization. His hospitalization costs will be covered under which device?","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Universal Health Protection (PUMa)","justification":""},{"idx":1,"correct":false,"proposition":"Complementary Universal Health Coverage (CMUc)","justification":""},{"idx":2,"correct":false,"proposition":"Assistance to complementary health (ACS)","justification":""},{"idx":3,"correct":false,"proposition":"Active solidarity income (RSA)","justification":""},{"idx":3,"correct":true,"proposition":"State Medical Aid (AME)","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-7-qi-5","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"This patient meets the conditions to benefit from the State Medical Aid (AME) but he has not, to date, submitted an application. Which of the following proposals for AME is correct?","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"The AME application must have been filed on the day of hospitalization","justification":""},{"idx":1,"correct":false,"proposition":"The hospital fee will remain the responsibility of the patient because he had not submitted an application for AME prior to his entry into the hospital","justification":""},{"idx":2,"correct":false,"proposition":"The AME will only allow him to access free emergency care","justification":""},{"idx":3,"correct":false,"proposition":"The AME will allow him to be reimbursed 100% of a medical consultation but he will have to advance the costs","justification":"No need to advance fees"},{"idx":4,"correct":true,"proposition":"The AME will allow him to be exempted from the medical deductible","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-7-qi-6","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"Following the information provided, the patient finally accepts the surgery and hospitalization. He was therefore taken to the operating room for an orthopedic procedure. Arriving at the operating room, the team uses the patient safety checklist << the operating room >> (2016 version) of the High Authority for Health (HAS). Which of the following proposals regarding the patient safety <<checklist in the >> operating room is which one is correct? ","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"The checklist is a barrier to recovery according to Reason's model","justification":"This is the famous model in Gruyère 🧀"},{"idx":1,"correct":false,"proposition":"The checklist checks safety points of care at 4 key moments of surgery: before anesthetic induction, before, during and after surgery","justification":""},{"idx":2,"correct":true,"proposition":"The checklist promotes the sharing of information through cross-checking","justification":""},{"idx":3,"correct":true,"proposition":"The checklist significantly reduces postoperative morbidity and mortality","justification":""},{"idx":4,"correct":false,"proposition":"The checklist must be co-signed by the surgeon, anaesthetist and patient as soon as they wake up","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-7-qi-7","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"The immediate aftermath of surgery is simple. The patient is now hospitalized. He is quickly seen by the mobile addiction team. The patient's clinical condition is stable and satisfactory. Postoperative pain is well controlled. There are no other notable clinical signs. Which of the following addiction consumption evaluation questionnaires is indicated in this patient? ","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"The Fagerstrom test","justification":""},{"idx":1,"correct":false,"proposition":"Cushman's score","justification":""},{"idx":2,"correct":true,"proposition":"The CAST questionnaire","justification":""},{"idx":3,"correct":true,"proposition":"The AUDIT questionnaire","justification":""},{"idx":4,"correct":false,"proposition":"The SPICES score","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-7-qi-8","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"During the appointment with the addictologist, in the presence of the translator, the patient reports an alcohol consumption equivalent to 6 standard drinks every day. He feels the need to have a first drink in the morning and has already been injured in a context of alcoholization in the last 12 months. The addictologist uses the AUDIT test. These elements of consumption are in favor (one or more possible answers): ","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Alcohol dependence ","justification":""},{"idx":1,"correct":false,"proposition":"The indication of a brief intervention only","justification":""},{"idx":2,"correct":true,"proposition":"Specialized addictological care","justification":""},{"idx":3,"correct":true,"proposition":"A risk of withdrawal syndrome","justification":""},{"idx":4,"correct":true,"proposition":"Misuse of alcohol","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-7-qi-9","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"As part of the prevention of alcohol withdrawal syndrome, the doctor of the department prescribes treatment with diazepam. The doctor on call is called during the following night because the patient has a state of convulsive status requiring a transfer to intensive care for 48 hours, lengthening the duration of hospitalization of this patient. Consultation of the patient's file during management by the doctor on duty shows that the patient has not received his diazepam treatment. You have no further information at this stage. How can we qualify this situation (one or more possible answers)? ","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"A risky event","justification":""},{"idx":1,"correct":true,"proposition":"An adverse event associated with care","justification":""},{"idx":2,"correct":true,"proposition":"A serious adverse event","justification":""},{"idx":3,"correct":true,"proposition":"A preventable adverse event","justification":""},{"idx":4,"correct":false,"proposition":"An unexpected side effect","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-7-qi-10","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"As part of the quality approach within the department, it is decided to investigate the causes responsible for the occurrence of this adverse event. Which method(s) is (are) suitable? ","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"A clinical audit","justification":""},{"idx":1,"correct":false,"proposition":"A clinical path","justification":""},{"idx":2,"correct":false,"proposition":"An analysis of failure modes, their effects and criticality","justification":""},{"idx":3,"correct":true,"proposition":"A mortality and morbidity review","justification":""},{"idx":4,"correct":false,"proposition":"A review of the relevance of care","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-7-qi-11","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"The analysis of this event in mortality and morbidity review aims to (one or more possible responses):","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Setting a priori the optimal care pathway","justification":"The MMR (Mortality and Morbidity Review) is carried out a posteriori, that is to say after the event has taken place."},{"idx":1,"correct":true,"proposition":"Carry out a collective analysis integrating all the professionals concerned by the event","justification":""},{"idx":2,"correct":false,"proposition":"Identify the culprit(s) at the origin of the fault","justification":"This is absolutely not the objective of quality approaches."},{"idx":3,"correct":true,"proposition":"Implement prevention, recovery or mitigation actions ","justification":""},{"idx":4,"correct":true,"proposition":"Identify root causes","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-7-qi-12","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"The ALARM method was used to identify the causes of this care-associated adverse event. The causes identified are as follows. First, a computer failure did not make it possible to carry out a computerized prescription. The prescription was made in a paper file that turned out to be that of a patient other than Mr. B. The prescription was made at the end of the morning nurses' shift. However, the computer failure was quickly resolved and the afternoon shift nurses were not informed of the computer failure. In the end, the computer failure concerned only Mr B.'s prescriptions. The prescriptions of the other patients of the department could be made on computer as is customary in this department. The patient did not speak French, and in the absence of an interpreter during hospitalization, there was a lack of communication. The nursing team was understaffed due to multiple work stoppages in the context of an influenza epidemic. The analysis of causes finds related factors (one or more possible answers):","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"To the work environment","justification":""},{"idx":1,"correct":true,"proposition":"To the organization of the service","justification":""},{"idx":2,"correct":true,"proposition":"How the team works","justification":""},{"idx":3,"correct":true,"proposition":"Patient characteristics","justification":""},{"idx":4,"correct":false,"proposition":"In the international context","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-7-qi-13","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"Following this adverse event associated with care, what should be done (one or more possible responses):","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Inform the patient that they have experienced an unwanted event","justification":""},{"idx":1,"correct":false,"proposition":"Explain to the patient that this event would not have occurred if they did not consume so much alcohol daily","justification":""},{"idx":2,"correct":true,"proposition":"Inform the patient that every effort has been made to understand the causes of this event and prevent it from happening again","justification":""},{"idx":3,"correct":false,"proposition":"Minimize the importance of this event as it has no sequelae","justification":""},{"idx":4,"correct":false,"proposition":"Offer, if necessary, spiritual support","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-8-qi-1","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"Which of the following clinical signs are the ones that immediately point to a surgical emergency:","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"The sudden onset of pain","justification":"The criteria for a surgical emergency include: high and sudden abdominal pain, contracture (defense to a lesser extent), signs of hypovolemic shock (tachycardia, hypotension), signs of septic shock (fever), etc. "},{"idx":1,"correct":false,"proposition":"Lack of defense or contracture","justification":""},{"idx":2,"correct":false,"proposition":"The analgesic position in a gun dog","justification":"This points to acute pancreatitis"},{"idx":3,"correct":false,"proposition":"The 2 episodes of vomiting","justification":"Vomiting is not a surgical emergency"},{"idx":4,"correct":false,"proposition":"The onset of periumbilical pain","justification":"Periumbilical pain is not a worrying localization"}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-8-qi-2","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"Which of the following diagnoses you think is most likely (an expected answer):","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Acute bowel obstruction","justification":""},{"idx":1,"correct":false,"proposition":"Sigmoid diverticulitis","justification":"The location of pain is not in favor (classically in left iliac fossa \/ left flank)"},{"idx":2,"correct":false,"proposition":"Infectious ileitis","justification":"Ileitis is much less likely than occlusion."},{"idx":3,"correct":false,"proposition":"Acute cholecystitis","justification":"The localization of the pain is not in favor (classically in right hypochondrium)"},{"idx":4,"correct":false,"proposition":"Acute salpingitis","justification":"We think rather of a digestive pathology here."}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-8-qi-3","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"The pulse is at 98 beats per minute, the BP at 110\/80 mmHg and the temperature at 37.8 °C.  Regarding emergency care, what is (are) the real proposal(s)? (one or more true answers)","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Nasogastric tube placement","justification":"Systematics in case of suspected occlusion"},{"idx":1,"correct":false,"proposition":"Placement of a urinary catheter","justification":""},{"idx":2,"correct":true,"proposition":"Placement of a peripheral venous line","justification":"Good caliber track"},{"idx":3,"correct":true,"proposition":"Level 3 analgesic treatment","justification":"In view of the EVA"},{"idx":4,"correct":true,"proposition":"Blood type and rhesus"}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-8-qi-4","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"Which examination(s) do you think are useful for the management of this patient?","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Abdominal ultrasound","justification":""},{"idx":1,"correct":true,"proposition":"Abdominopelvic CT scan with contrast injection","justification":""},{"idx":2,"correct":false,"proposition":"Entero-MRI","justification":""},{"idx":3,"correct":false,"proposition":"X-ray of abdomen without face preparation","justification":"No longer 😊 done"},{"idx":4,"correct":false,"proposition":"Esogastric endoscopy","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-8-qi-5","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"An abdomino-pelvic CT scan is performed. Which of the following is correct?","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"It is an abdominal CT scan with injection, arterial time","justification":"The spleen is no longer tabby 👉 it is not arterial"},{"idx":1,"correct":false,"proposition":"This is an axial cut","justification":"Coronal Cup"},{"idx":2,"correct":false,"proposition":"The superior mesenteric artery is clouded and visible on this picture","justification":""},{"idx":3,"correct":true,"proposition":"A digestive loop is distended","justification":""},{"idx":4,"correct":true,"proposition":"There is a peritoneal effusion","justification":"Next to the liver"}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-8-qi-6","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"The CT scan confirms the hypothesis of a small bowel occlusion on flange with suffering of a small loop and presence of a peritoneal effusion. What do you propose at this stage? ","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Check the blood ionogram to adapt the ionic intake","justification":""},{"idx":1,"correct":false,"proposition":"Hospitalization, fasting, continuation of analgesic treatment and transit accelerators, clinical and biological reassessment at 24 h","justification":"Occlusion on flange + digestive suffering does not allow to wait"},{"idx":2,"correct":true,"proposition":"Contact the surgical and anesthetic team for emergency intervention","justification":""},{"idx":3,"correct":true,"proposition":"Starting intravenous probabilistic antibiotic therapy","justification":""},{"idx":4,"correct":false,"proposition":"Perform a rectosigmoidoscopy to lift the flange","justification":"Can be done in the volvulus of the sigmoid"}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-8-qi-7","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"You decide to operate on the patient. A laparotomy is performed, you discover a flange responsible for strangulation of the ileum with ischemia of the small intestine for about 1 meter. Which of the following suggestions regarding your care is true? ","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Section as quickly as possible of the flange responsible for strangulation","justification":""},{"idx":1,"correct":false,"proposition":"Rapid resection of the ischemic digestive segment to avoid bacterial translocation","justification":""},{"idx":2,"correct":true,"proposition":"Installation of moist and warm compresses in contact with the ischemic intestine and reassess its recoloration and vitality after a few minutes","justification":""},{"idx":3,"correct":true,"proposition":"The entire small intestine should be unwound to look for other flanges that may cause occlusions","justification":""},{"idx":4,"correct":true,"proposition":"You have informed the patient of the possibility of a stoma after the procedure","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-8-qi-8","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"You perform a resection-anastomosis of the hail. The patient is renourished on day 2. On the 5th day, she complains of diffuse abdominal pain, predominant at the periumbilical level. The temperature is 38.5 °C.  The examination finds a painful arch at the level of the operative scar. Which of the following diagnoses can you mention?","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"A wall abscess"},{"idx":1,"correct":true,"proposition":"An anastomotic fistula"},{"idx":2,"correct":false,"proposition":"Early recurrence of flange occlusion","justification":""},{"idx":3,"correct":true,"proposition":"A covered evisceration"},{"idx":4,"correct":false,"proposition":"A bladder globe "}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-8-qi-9","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"What test(s) do you request to support your diagnosis? (one or more responses)","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"No further examination","justification":""},{"idx":1,"correct":false,"proposition":"A suprapubic ultrasound","justification":""},{"idx":2,"correct":true,"proposition":"An abdominal CT scan with injection","justification":""},{"idx":3,"correct":false,"proposition":"An abdominal x-ray without preparation","justification":""},{"idx":4,"correct":false,"proposition":"A rectosigmoidoscopy to remove an anastomotic fistula","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-8-qi-10","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"The abdominal CT scan ordered urgently shows a wall abscess. The abscess is evacuated. The patient leaves the ward with local care at home with a 5-week absence from work. Why should she see the occupational physician again when resuming (one or more possible answers):","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Because the event occurred in the workplace","justification":""},{"idx":1,"correct":true,"proposition":"Because it's a stop of more than 30 days","justification":"The three situations that require a follow-up visit are: occupational disease, stoppage > 30J, maternity leave."},{"idx":2,"correct":true,"proposition":"To adapt the workstation if necessary","justification":""},{"idx":3,"correct":false,"proposition":"To approve!' Imputability of the accident at work","justification":""},{"idx":4,"correct":false,"proposition":"To determine the rate of disability related to the work-related accident","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-8-qi-11","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"She is seen again in consultation at his request 6 months later for the appearance of a << ball >> in front of his scar. On examination, there is an impulsive cough swelling, not painful. Which of the following diagnoses can be mentioned?","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"A covered evisceration","justification":"The peritoneum does not 👉 hold evisceration. According to the College of Digestive Surgery: 'Early post-operative injury'"},{"idx":1,"correct":true,"proposition":"An uncomplicated eventration","justification":"The peritoneum holds 👉 ventration. According to the College of Digestive Surgery: 'Hernia through an opening secondary to a previous incision'"},{"idx":2,"correct":false,"proposition":"A recurrence of the wall abscess","justification":""},{"idx":3,"correct":false,"proposition":"A keloid scar","justification":""},{"idx":4,"correct":false,"proposition":"A parietal lipoma","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-8-qi-12","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"Given the impulsive nature of coughing and not painful, you evoke an uncomplicated eventration. Do you inform the patient that? ","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Wearing a restraint belt for 6 months prevents their occurrence","justification":""},{"idx":1,"correct":true,"proposition":"An eventration always occurs on an acquired aponeurotic orifice","justification":"This is the definition 😊"},{"idx":2,"correct":true,"proposition":"Surgery is responsible for venting in the majority of cases","justification":"It is exceptionally post-traumatic."},{"idx":3,"correct":false,"proposition":"She should have had a work stoppage of at least 3 months to prevent the ventration","justification":""},{"idx":4,"correct":true,"proposition":"The occurrence of a parietal abscess is a risk factor for the occurrence of eventration","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-8-qi-13","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"You propose to the patient a surgical cure of the eventration. But she refuses this intervention. Three years later, she was admitted urgently for acute abdominal pain. Which of the following proposals will direct you towards the diagnosis of strangled ventration? ","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Painful swelling","justification":""},{"idx":1,"correct":true,"proposition":"Irreducibility of eventration","justification":""},{"idx":2,"correct":true,"proposition":"Occurrence of iterative vomiting","justification":""},{"idx":3,"correct":false,"proposition":"Conjunctival jaundice","justification":""},{"idx":4,"correct":true,"proposition":"Loss of impulsivity at cough","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-8-qi-14","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"You make the diagnosis of strangulated ventration and the patient is operated urgently. There is no digestive suffering and the fascia is closed by a simple suture. The postoperative follow-up is simple and the patient leaves the service at 5 quality of general practitioner, you see the patient again 8 days later at home and you inform her ","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"That, in its situation, the aponeurotic suture guarantees the absence of recurrence in 90% of cases","justification":""},{"idx":1,"correct":false,"proposition":"That the wearing of a restraint belt is recommended 24 hours a day","justification":""},{"idx":2,"correct":true,"proposition":"That it would be advisable to contact the occupational physician of his company","justification":""},{"idx":3,"correct":true,"proposition":"That in case of recurrence of its eventration, the installation of a parietal reinforcement prosthesis would be recommended","justification":""},{"idx":4,"correct":false,"proposition":"That you cannot ask his surgeon for his entire hospitalization file because of medical confidentiality","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-9-qi-1","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"Which of the following are the clinically severe symptoms(s) you are looking for in this child:  ","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"The child does not respond to the pain","justification":"In both children and adults, it is a sign of clinical seriousness"},{"idx":1,"correct":true,"proposition":"Heart rate is at 60 beats per minute","justification":"The threshold is 80 bpm"},{"idx":2,"correct":true,"proposition":"Breathing is irregular","justification":""},{"idx":3,"correct":true,"proposition":"She has fever and a rash that persists on vitropressure","justification":"The rash that persists with vitropressure is purpura, i.e. blood extravasation (blood coming out of the vessels). Any febrile purpura is a fulminans purpura until proven otherwise, and requires the introduction of antibiotic therapy as a matter of absolute urgency (even before bacteriological sampling if these delay management)."},{"idx":4,"correct":false,"proposition":"There is a notion of recent travel","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-9-qi-2","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"There is no rash or fever. In the absence of a verbal and motor response described by the mother as well as breathing that you hear as very slow and noisy, you send a team home. On the spot the doctor notes: a heart rate at 80 \/ min, a respiratory rate at 10 \/ min, a pink but sleepy child with a Glasgow score at 11, the temperature is at 36.2 ° C, skin recoloration is immediate and blood pressure is 102\/61 mmHg. The pupils are symmetrical and responsive, the nape is flexible. The mother does not report any unusual items in the previous days (no fever, no trauma). Which diagnosis(s) are compatible with this clinical picture? ","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Bacterial meningitis","justification":"The pupils are symmetrical and responsive, the nape is flexible."},{"idx":1,"correct":true,"proposition":"Trauma inflicted","justification":""},{"idx":2,"correct":true,"proposition":"Status epilepticus","justification":"a pink but sleepy child with a Glasgow score of 11"},{"idx":3,"correct":true,"proposition":"Exogenous poisoning","justification":""},{"idx":4,"correct":true,"proposition":"Hereditary abnormality of metabolism","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-9-qi-3","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"Regarding the hypothesis of a inflicted head trauma, what is (are) the exact proposal(s) in this pathology? ","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"The age of the child is evocative","justification":""},{"idx":1,"correct":false,"proposition":"The absence of impact on the skull excludes this diagnosis","justification":""},{"idx":2,"correct":false,"proposition":"Disorders of consciousness are rare","justification":""},{"idx":3,"correct":true,"proposition":"The break of the cranial perimeter curve is suggestive","justification":""},{"idx":4,"correct":true,"proposition":"Look for a subdural hematoma","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-9-qi-4","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"As a general rule, under what circumstances can bradypnea be observed in children? ","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"In case of opiate poisoning","justification":""},{"idx":1,"correct":false,"proposition":"In case of metabolic acidosis","justification":"Polypnea"},{"idx":2,"correct":true,"proposition":"In case of hypoxia","justification":""},{"idx":3,"correct":false,"proposition":"In case of carbon monoxide poisoning","justification":"Neurological impairment"},{"idx":4,"correct":false,"proposition":"In case of paracetamol poisoning","justification":"Liver damage"}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-9-qi-5","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"The arterial gas balance made under oxygen is as follows: pH 7.26, PCO2 66 mmHg, Bicarbonates 24 mmol \/ L, HbCO 3%, PO2 90 mmHg. How do you interpret this balance sheet (only one answer)? ","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Compensated respiratory acidosis","justification":""},{"idx":1,"correct":true,"proposition":"Uncompensated respiratory acidosis","justification":"Acidosis because pH<7.35 (or 7.38 depending on the source). Respiratory because the drop in pH is caused by the increase in pCO2 (which is > 45). Not compensated because the pH is acidic."},{"idx":2,"correct":false,"proposition":"Compensated metabolic acidosis","justification":""},{"idx":3,"correct":false,"proposition":"Uncompensated metabolic acidosis","justification":""},{"idx":4,"correct":false,"proposition":"Mixed acidosis","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-9-qi-6","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"The child is admitted to the emergency room where you decide to perform a brain scan and prescribe a urine toxicity test. Which symptom(s) is compatible with drug poisoning? (one or more exact propositions)","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Urinary retention","justification":""},{"idx":1,"correct":true,"proposition":"Cyanosis","justification":""},{"idx":2,"correct":false,"proposition":"Hives","justification":""},{"idx":3,"correct":true,"proposition":"Nausea and vomiting","justification":""},{"idx":4,"correct":false,"proposition":"Pupillary asymmetry","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-9-qi-7","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"Here are the growth curves that you reconstitute in the health record. What diagnostic hypothesis(s) can (s) be evoked when reading these curves?","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Hydrocephalus"},{"idx":1,"correct":false,"proposition":"Craniopharyngioma"},{"idx":2,"correct":true,"proposition":"Congenital immunodeficiency","justification":""},{"idx":3,"correct":false,"proposition":"Syndrome de Turner"},{"idx":4,"correct":true,"proposition":"Psychosocial dwarfism"}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-9-qi-8","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"The search for toxic substances finds cannabis. The mother reports that her husband had friends the day before and that it is possible that they had left cannabis resin on the coffee table that the child would have ingested at the time. You also note on clinical examination gingival hypertrophy, cavities, pallor, some petechiae in the lower limbs. What first-line investigation(s) is (are) necessary in view of these growth charts and clinical signs?","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"A complete blood count","justification":"Because of petechiae and pallor"},{"idx":1,"correct":false,"proposition":"An X-ray of a skull","justification":""},{"idx":2,"correct":false,"proposition":"A weight assay of immunoglobulins","justification":""},{"idx":3,"correct":false,"proposition":"A FSH-LH assay","justification":""},{"idx":4,"correct":false,"proposition":"A CMV serology","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-9-qi-9","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"The complete blood count shows a hemoglobin of 9.8 g\/dL, with a MCV of 68 fL, the platelet count of 525 G\/L. Which of the following do you think is the most likely diagnosis based on history, clinical signs and laboratory results? ","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Nutritional deficiency","justification":"Anemia is probably iron deficiency"},{"idx":1,"correct":false,"proposition":"Crohn's disease","justification":""},{"idx":2,"correct":false,"proposition":"Cystic fibrosis","justification":""},{"idx":3,"correct":false,"proposition":"Biermer's disease","justification":"Anemia would be rather macrocytic"},{"idx":4,"correct":false,"proposition":"Hepatocellular insufficiency","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-9-qi-10","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"The dietary survey confirms your hypothesis of serious deficiency on an inadequate diet, since the child drinks only semi-skimmed cow's milk, sugary drinks and nibbles cakes. Regarding the recommended dietary and vitamin allowances at this age, which is (are) accurate? ","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Fluoride supplementation is recommended for all children from birth","justification":"You don't have teeth at birth 🦷😬"},{"idx":1,"correct":false,"proposition":"A vitamin C supplement is necessary in winter","justification":""},{"idx":2,"correct":false,"proposition":"Growing up milk can be replaced by cow's milk from 18 months","justification":""},{"idx":3,"correct":false,"proposition":"Breastfeeding provides adequate iron intake at this age","justification":""},{"idx":4,"correct":true,"proposition":"Infant formulas are fortified with vitamin D","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-9-qi-11","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"You consult his health record. At 2 months: hexavalent and pneumococcal conjugate vaccine with 13 valences. at 6 months: hexavalent and pneumococcal conjugate vaccine with 13 valences. At 7 months: meningococcal C. vaccination at 12 months: hexavalent and pneumococcal conjugate vaccine with 13 valences. There has been no medical examination since the age of 12 months. Regarding the vaccination recommendations in force for this 18-month-old infant, what is the exact proposal(s)? (one or more true propositions)","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Meningococcal C vaccine is missing","justification":"Two in total"},{"idx":1,"correct":true,"proposition":"One dose of hepatitis vaccine is missing","justification":"3 total"},{"idx":2,"correct":true,"proposition":"At least one dose of measles\/mumps\/rubella (MMR) vaccine is missing","justification":"2 in total, at 12 then 16-18 months"},{"idx":3,"correct":false,"proposition":"One dose of 23-valent pneumococcal polysaccharide vaccine is missing","justification":"13 valances"},{"idx":4,"correct":false,"proposition":"Missing dose of varicella vaccine","justification":"No mandatory varicella vaccine, nor recommended at this age (it is in adolescents and adults who were not infected in childhood)"}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-9-qi-12","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"You are also worried about the psychomotor development of this 18-month-old child, who has very little stimulation from parents and spends her days in front of the television screen. Which of these propositions is (are) accurate?","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Walking must be acquired","justification":""},{"idx":1,"correct":true,"proposition":"The child knows how to drink alone","justification":""},{"idx":2,"correct":false,"proposition":"Their language must be at least 100 words long","justification":""},{"idx":3,"correct":true,"proposition":"It combines 2 to 3 words","justification":""},{"idx":4,"correct":true,"proposition":"The child can stack 2 cubes","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-9-qi-13","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"This child's language is dissyllabic, she does not associate two words and does not react to the call of her name. She stands alone and takes a few steps when invited but is spontaneously << very calm >>. Which of the following investigations should be carried out in the first line? ","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"An ENT consultation for audiometry","justification":"Deafness must be eliminated in front of this clinical description. It is a common cause of delayed psychomotor development."},{"idx":1,"correct":false,"proposition":"A CPK assay","justification":""},{"idx":2,"correct":false,"proposition":"Evoked potentials of the brainstem","justification":""},{"idx":3,"correct":false,"proposition":"An electromyogram","justification":""},{"idx":4,"correct":false,"proposition":"An ophthalmological examination","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-9-qi-14","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"The ENT consultation finds normal hearing, you retain a deficiency origin to this psychomotor delay. Faced with this table of accidental poisoning and serious deficiency of food intake, irregular medical monitoring (with vaccination delay), what step(s) do you think is necessary? (one or more true propositions)","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"A phone call from the gendarmerie","justification":"This is not the regulatory route"},{"idx":1,"correct":true,"proposition":"A report to the public prosecutor","justification":""},{"idx":2,"correct":false,"proposition":"A report to the Regional Health Agency","justification":"The ARS is not concerned"},{"idx":3,"correct":false,"proposition":"Worrying information at the High Authority of Health (HAS)","justification":"The HAS is not concerned"},{"idx":4,"correct":false,"proposition":"A phone call to the child's doctor and the Maternal Child Protection","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-9-qi-15","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"You write a judicial report. Which of the following is correct? ","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"The name of the medical writer(s) must remain anonymous","justification":"It must be clearly identified"},{"idx":1,"correct":false,"proposition":"He must suggest the person responsible for the abuse","justification":"It must be objective and descriptive"},{"idx":2,"correct":false,"proposition":"It must be given to both parents","justification":"Parents may be informed, unless the child is in the best interests of the contrary"},{"idx":3,"correct":true,"proposition":"It must mention the identity of the persons holding parental authority","justification":""},{"idx":4,"correct":false,"proposition":"Parents must be informed of the report","justification":"Unless otherwise interested of the child"}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-11-qi-1","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"What element(s) do you look for in the clinical examination of the patient who may participate in infertility? ","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Positive Prehn's sign","justification":"We do not think of acute orchitis in this context"},{"idx":1,"correct":true,"proposition":"Unilateral gynecomastia","justification":""},{"idx":2,"correct":true,"proposition":"Cryptorchidism","justification":""},{"idx":3,"correct":true,"proposition":"Hair abnormality","justification":""},{"idx":4,"correct":false,"proposition":"Ligament hyperlaxity","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-11-qi-2","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"The patient has already made a spermogram after 4 days of abstinence of which he shows you the results: ejaculated volume at 5 ml, sperm concentration: 2 million \/ ml, total sperm motility: 10%, 75% spermatozoa, 1% normal forms. What are the exact proposal(s)?","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"There is hypospermia","justification":"Threshold at 1.5 mL"},{"idx":1,"correct":true,"proposition":"There is oligospermia","justification":"Threshold at 15 million\/mL"},{"idx":2,"correct":true,"proposition":"There is teratospermia","justification":"1% is not much 😉"},{"idx":3,"correct":false,"proposition":"There is necrospermia","justification":"Well, we don't know what the 75% means (are these normal or dead spermatozoa?), so we don't tick"},{"idx":4,"correct":true,"proposition":"There is asthenospermia","justification":"10% mobility is not much at all 😅"}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-11-qi-3","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"No etiology is found to these spermogram abnormalities explaining infertility and pregnancy is obtained by intracytoplasmic injection of spermatozoa. The 1 trimester of pregnancy passes without difficulty except for nausea and some bleeding of red blood. The patient consults at 27 SA because her last two urine strips showed the presence of leukocytes and nitrites. She has no fever, no urinary symptoms apart from slight cough leakage. She has had a recurrent cough since the beginning of winter. She therefore restricts herself from drinking to limit leakage. What is the most likely diagnosis? (only one answer expected)","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Urogenital tuberculosis","justification":""},{"idx":1,"correct":false,"proposition":"Cystitis","justification":""},{"idx":2,"correct":true,"proposition":"Urinary colonization","justification":""},{"idx":3,"correct":false,"proposition":"Molar pregnancy","justification":""},{"idx":4,"correct":false,"proposition":"Bladder lithiasis","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-11-qi-4","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"You have a cytobacteriological examination of urine performed which shows: 42000 red blood cells \/ ml, 12000 leukocytes per mL, and 10 power 5 E. Coli \/ mL in culture. What do you do?","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Amoxicillin treatment should be started as a first-line treatment","justification":""},{"idx":1,"correct":false,"proposition":"First-line fosfomycin-trometamol therapy should be started","justification":""},{"idx":2,"correct":true,"proposition":"It is necessary to wait for the results of the susceptibility test to treat","justification":""},{"idx":3,"correct":false,"proposition":"Intravenous dual antibiotic therapy is needed","justification":""},{"idx":4,"correct":true,"proposition":"There is a risk of acute pyelonephritis if left untreated","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-11-qi-5","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"Escherichia coli colonization recurs several times during pregnancy and required 4 lines of antibiotic treatment. The patient gives birth at 38 SA+ 4 J of a little girl of 4180 g vaginally without episiotomy. Three weeks later, she consults for an alteration of the general condition, a fever at 38.8 ° C, urinary functional signs such as pollakiuria and leakage with effort and pain that she has difficulty systematizing but predominant in the right hemiabdomen. Her daughter is formula-fed and is doing well. What diagnosis(s) are possible at this stage? ","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Cystitis","justification":""},{"idx":1,"correct":true,"proposition":"Endometritis","justification":""},{"idx":2,"correct":true,"proposition":"Pyelonephritis","justification":""},{"idx":3,"correct":false,"proposition":"Renal colic","justification":""},{"idx":4,"correct":true,"proposition":"Pelvic thrombophlebitis","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-11-qi-6","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"On clinical examination the vaginal touch is painless, the breasts are flexible, there is pain at the shaking of the right lumbar fossa with a painful path radiating in addition pubic. Cardiopulmonary auscultation finds a decrease in vesicular murmur in the right base. The patient is febrile at 38.7°C, heart rate is 132\/min and blood pressure is 87\/53 mmHg. Which exam(s) are you asking for as a first line?","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Doppler ultrasound of the lower limbs","justification":""},{"idx":1,"correct":true,"proposition":"Cytobacteriological examination of urine","justification":""},{"idx":2,"correct":true,"proposition":"Renal imaging"},{"idx":3,"correct":false,"proposition":"D-dimer"},{"idx":4,"correct":true,"proposition":"Blood"}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-11-qi-7","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"The imagery is as follows. Which proposal(s) is the exact proposal(s): (one or more expected proposals)","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"These are cuts of abdominal-pelvic CT scan after injection of contrast medium","justification":""},{"idx":1,"correct":true,"proposition":"There is dilation of the right pyelocalicial cavities","justification":""},{"idx":2,"correct":false,"proposition":"There is a right pyelic calculation","justification":""},{"idx":3,"correct":true,"proposition":"There is a right ureteral calculus","justification":""},{"idx":4,"correct":false,"proposition":"There is a syndrome of right kidney mass","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-11-qi-8","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"The abdominopelvic CT scan therefore shows a dilation of the right pyelocalicial cavities upstream of a 7 mm ureteral stone. Direct examination of urine shows the presence of leukocytes, red blood cells and gram-negative bacilli. As she returned from the CT scan, the patient's blood pressure dropped to 65\/30 mmHg and the lumbar fossa pain intensified. Her state of consciousness is normal, she has some mottling on her knees. What therapeutic measure(s) is possible in the first line? ","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"No measures should delay surgical management","justification":""},{"idx":1,"correct":true,"proposition":"Crystalloid-like solute filling","justification":""},{"idx":2,"correct":false,"proposition":"Parenteral bi-antibiotic therapy with fluoroquinolone and aminoglycoside","justification":""},{"idx":3,"correct":true,"proposition":"Parenteral bi-antibiotic therapy with beta-lactam and aminoglycoside","justification":""},{"idx":4,"correct":true,"proposition":"Administration of vasopressive drug type noradrenaline","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-11-qi-9","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"The patient responds well to crystalloid filling and her blood pressure is now stabilized at 100\/58 mmHg. What additional therapeutic measure do you propose in this context? (only one answer expected)","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Nonsteroidal anti-inflammatory drugs","justification":""},{"idx":1,"correct":true,"proposition":"Urine drainage by JJ or ureteral tube","justification":""},{"idx":2,"correct":false,"proposition":"Urine drainage by bladder tube alone","justification":""},{"idx":3,"correct":false,"proposition":"Ureteroscopy for stone extraction after 48 h of effective antibiotic therapy","justification":""},{"idx":4,"correct":false,"proposition":"Ureteral drainage by JJ tube after 48 h of effective antibiotic therapy","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-11-qi-10","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"After the placement of a JJ tube (non-purulent urine) and 72 hours of adapted antibiotic therapy, the patient's clinical condition improves and she can go home. You see it again in consultation 1 month later and the CT scan without injection shows that the stone has been pushed back into the upper calyx. It always measures 7 mm and its density is 1050 UH. The JJ tube is quite poorly tolerated with pollakiuria and almost permanent pain. What are the possible measures for the continuation of the care (one or more correct answers):","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"JJ probe removal and monitoring","justification":""},{"idx":1,"correct":true,"proposition":"Extracorporeal lithotripty","justification":""},{"idx":2,"correct":true,"proposition":"Ureteroscopy extraction","justification":""},{"idx":3,"correct":false,"proposition":"Percutaneous nephrolithotomy","justification":""},{"idx":4,"correct":false,"proposition":"Iterative changes to the JJ probe","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-11-qi-11","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"You finally decide to perform a flexible ureteroscopy with extraction of all the lithiasic fragments that are sent for analysis. Given the elements at your disposal, what is the most likely majority component of this calculation? ","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Calcium oxalate","justification":""},{"idx":1,"correct":false,"proposition":"Struvite","justification":""},{"idx":2,"correct":false,"proposition":"Medicated lithiasis","justification":""},{"idx":3,"correct":false,"proposition":"Cystine","justification":""},{"idx":4,"correct":false,"proposition":"Uric acid","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-11-qi-12","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"Infrared spectrophotometry concludes that it is a calculation composed of 75% whewellite (calcium oxalate monohydrate), 25% wedellite (calcium oxalate dihydrate). What can be the contributing factor(s) of such a calculation in this patient?","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Primary hyperparathyroidism","justification":""},{"idx":1,"correct":false,"proposition":"Hypocalciuria"},{"idx":2,"correct":false,"proposition":"Recurrent urinary tract infections","justification":""},{"idx":3,"correct":true,"proposition":"Inadequate water intake","justification":""},{"idx":4,"correct":false,"proposition":"Protein intakes too low","justification":"Too important"}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-11-qi-13","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"The first-line etiological assessment you prescribed is normal. What recurrence prevention measure(s) are you putting in place?","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Decreased calcium intake (< 400 mg\/d)","justification":"800-1000 mg\/day"},{"idx":1,"correct":true,"proposition":"Decrease in sodium intake (6 g\/d)","justification":""},{"idx":2,"correct":false,"proposition":"Hydration for a diuresis volume of about 1 L","justification":"2L"},{"idx":3,"correct":false,"proposition":"Alkalization of urine"},{"idx":4,"correct":false,"proposition":"Weekly antibiotic prophylaxis","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-11-qi-14","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"The patient comes back to see you 4 years later because she thinks her stones are recurring. However, she experienced a second pregnancy without lithiasis recurrence and gave birth without difficulty to a little boy weighing 3560 grams 18 months ago. For the past few weeks, she has felt embarrassed by a bladder stone that frequently makes her want to urinate day and night. She feels pelvic heaviness aggravated by prolonged standing. Her needs are so urgent that she can't always restrain herself. On the other hand, his cough leaks disappeared except possibly in the morning when he woke up. Sexual intercourse is unpleasant. What is the most likely diagnostic hypothesis?","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Lithiasis enclosed in the urethra","justification":""},{"idx":1,"correct":false,"proposition":"Urinary tract infection","justification":""},{"idx":2,"correct":true,"proposition":"Genital prolapse","justification":""},{"idx":3,"correct":false,"proposition":"Carcinoma in situ","justification":""},{"idx":4,"correct":true,"proposition":"uterine fibroid","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-11-qi-15","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"Your clinical examination confirms the presence of a grade 3 anterior colpocele. What is the most plausible explanation for the disappearance of stress urinary incontinence: (one exact proposition)","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Lithiasis enclosed in the urethra","justification":""},{"idx":1,"correct":false,"proposition":"Childbirth-related synechia","justification":""},{"idx":2,"correct":true,"proposition":"Plication of the urethra by the colpocele","justification":""},{"idx":3,"correct":false,"proposition":"Sequelae of urinary tract infections","justification":""},{"idx":4,"correct":false,"proposition":"Urethral calcification by calcium oxalate","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-12-qi-1","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"What is the most relevant information to look for during the interview or clinical examination? ","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Abdominal pain","justification":"The main question is: is it a GEU? The absence of abdominal pain would then be very reassuring."},{"idx":1,"correct":false,"proposition":"An open neck","justification":""},{"idx":2,"correct":false,"proposition":"Abundant metrorrhagia","justification":""},{"idx":3,"correct":false,"proposition":"A uterus too large for the term","justification":""},{"idx":4,"correct":false,"proposition":"An exacerbation of sympathetic signs of pregnancy","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-12-qi-2","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"In this patient, physical examination reveals moderate pain caused in the defenseless right iliac fossa. Blood pressure is at 130\/70 mmHg. The heart rate is at 80 bpm. The uterus is impalpable due to the patient's overweight. On examination under speculum, moderate red bleeding comes from the endocervix. At vaginal touch, there is no mass, but palpation of the right cul-de-sac triggers moderate pain. Which diagnosis do you prefer at this stage of management? ","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Ectopic pregnancy","justification":"Priority is always given to the most serious and urgent 😉"},{"idx":1,"correct":false,"proposition":"Non-progressive intrauterine pregnancy","justification":""},{"idx":2,"correct":false,"proposition":"Molar pregnancy","justification":""},{"idx":3,"correct":false,"proposition":"Active intrauterine pregnancy","justification":""},{"idx":4,"correct":false,"proposition":"Spontaneous abortion in progress","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-12-qi-3","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"Following your clinical examination, you decide to perform an endovaginal pelvic ultrasound. Which ultrasound sign(s) would be compatible with the diagnosis of ectopic pregnancy?","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Thickening of the endometrium","justification":""},{"idx":1,"correct":true,"proposition":"Absence of effusion in the rectouterine cul-de-sac (Douglas)","justification":""},{"idx":2,"correct":true,"proposition":"Absence of visible right laterouterine mass","justification":""},{"idx":3,"correct":true,"proposition":"Corpus luteum on the right ovary","justification":""},{"idx":4,"correct":true,"proposition":"Hypoechoic intrauterine image without hyperechoic crown","justification":"Everything is 'compatible'"}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-12-qi-4","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"The pelvic ultrasound you perform shows uterine emptiness, no intra-abdominal effusion and no visible adnexal mass. Plasma HCG is measured at 900 IU\/L. What therapeutic strategy do you adopt (only one expected response)?","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Intramuscular injection of methotrexate on an outpatient basis","justification":""},{"idx":1,"correct":false,"proposition":"Laparoscopy explorer","justification":""},{"idx":2,"correct":false,"proposition":"Administration of oral misoprostol on an outpatient basis","justification":""},{"idx":3,"correct":true,"proposition":"Expectancy and reassessment within 48 h with new HCG assay and control ultrasound","justification":""},{"idx":4,"correct":false,"proposition":"Endorish aspiration with sending of samples in anatomical pathology for chorionic villus testing","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-12-qi-5","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"You see the patient again two days later. She still feels a slight pain in the right iliac fossa. Minimal metrorrhagia persist. The HCGs are at 1200 in the same laboratory. The control ultrasound reveals this time a hematosalpinx of 20mm on the right, without visible embryo and without abdominal effusion. Your increased suspicion of ectopic pregnancy therefore leads you to prescribe methotrexate. Which proposals are correct?","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Folic acid should be systematically combined","justification":""},{"idx":1,"correct":true,"proposition":"A transient increase in HCG is usual","justification":""},{"idx":2,"correct":false,"proposition":"It may be accompanied by hand-foot syndrome","justification":""},{"idx":3,"correct":true,"proposition":"The success rate is correlated with the HCG rate","justification":""},{"idx":4,"correct":false,"proposition":"A tubal rupture can occur","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-12-qi-6","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"What advice(s) do you give to the patient? ","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Absolute contraindication to microprogestogens","justification":""},{"idx":1,"correct":false,"proposition":"Need for early pelvic ultrasound in case of new pregnancy","justification":"We have not found this notion even if it would seem logical 🤔 to us"},{"idx":2,"correct":false,"proposition":"Respect a minimum of 6 months after the injection of methotrexate to start a new pregnancy","justification":"The recommended period is 3 months"},{"idx":3,"correct":true,"proposition":"Smoking cessation","justification":"Always always"},{"idx":4,"correct":false,"proposition":"Perform a hysterosalpingography to assess tubal patency","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-12-qi-7","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"Two years after the management of this ectopic pregnancy, the patient returns to consult as part of the follow-up of a new pregnancy. This pregnancy is desired. It is at 12 SA. She has no symptoms. It brings you the result of the early pregnancy assessment prescribed by its general practitioner: blood group O rhesus negative, negative search for irregular agglutinins, rubella serology IgG +, serology toxoplasmosis IgG + \/ lgM-, HBsAg-, TPHA-VDRL-, HIV serology- You take the opportunity to perform a urine strip, it reveals 2 blood crosses and 2 protein crosses, no leukocytes or nitrites. Blood pressure is measured at 130\/80 mmHg. What is (are) your prescription(s)? ","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Quantification of urinary red blood cells by ECBU","justification":"Positive BU -> ECBU of confirmation and precision"},{"idx":1,"correct":true,"proposition":"Renal ultrasound","justification":""},{"idx":2,"correct":false,"proposition":"Cystoscopy","justification":""},{"idx":3,"correct":true,"proposition":"Proteinuria\/creatinine ratio","justification":""},{"idx":4,"correct":false,"proposition":"Uroscanner","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-12-qi-8","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"The next day (12+1 SA), you receive the results of the prescribed examinations. The ECBU is sterile 3 but confirms a red blood cell rate of 10 red blood cells\/mm. The proteinuria\/creatinine ratio is 40 mg\/mmol. Ultrasound shows the absence of kidney malformation and normal-sized kidneys without macroscopic cysts as well as a bladder without abnormalities. The plasma creatinine assay is 50 micromoL\/L. What etiology(ies) is (are) compatible with the whole picture presented by this patient?","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Pre-eclampsia"},{"idx":1,"correct":true,"proposition":"Alport syndrome"},{"idx":2,"correct":false,"proposition":"Stenosis of the renal arteries","justification":""},{"idx":3,"correct":true,"proposition":"lgA nephropathy"},{"idx":4,"correct":false,"proposition":"Autosomal dominant polycystic disease","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-12-qi-9","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"Given the probable existence of nephropathy pre-existing to pregnancy, a consultation with a nephrologist is scheduled. In the absence of renal failure, the latter provides for a renal biopsy to be performed once the pregnancy is over. \nThe monitoring of pregnancy subsequently proves satisfactory, especially in terms of blood pressure. At 31 weeks, the patient consults for decreased fetal active movements. She is also asymptomatic. Its temperature is 37 °C.  His blood pressure is 140\/80 mmHg. The uterine height is measured at 26 cm. His osteotendinous reflexes are normal. Fetal cardio monitoring is normal. \nYou perform a fetal ultrasound. Fetal biometrics include: biparietal diameter at 258 percentile, cephalic perimeter at 308 percentile, abdominal perimeter at 58 percentile, femur length 48 percentile, fetal weight estimate at 38 percentile. The uterine Doppler has a decreased diastole on both sides, without notch. The umbilical Doppler has zero diastole. The cerebral Doppler has an increased diastole. There is no visible fetal malformation. The amount of amniotic fluid is decreased. \nWhat argument(s) support(s) the hypothesis of a vasculo-placental cause that can explain these biometrics?","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Decreased diastole on uterine Doppler","justification":""},{"idx":1,"correct":true,"proposition":"Decreased amount of amniotic fluid","justification":""},{"idx":2,"correct":false,"proposition":"Absence of uterine Doppler \"notch\"","justification":"It is a present notch that directs us to a vascular cause"},{"idx":3,"correct":true,"proposition":"Preserved cephalic biometrics","justification":""},{"idx":4,"correct":true,"proposition":"Increased diastole on cerebral Doppler","justification":"This is a sign of brain adaption"}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-12-qi-10","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"Given this small fetus for gestational age, you decide to hospitalize the patient for fetal heart rate monitoring 3 times a day. What therapeutic measure(s) do you decide to implement? ","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Fetal lung maturation corticosteroid therapy","justification":"<34 Ltd"},{"idx":1,"correct":false,"proposition":"Tocolysis by atosiban","justification":""},{"idx":2,"correct":false,"proposition":"Magnesium sulphate","justification":"< 32 SA if imminent delivery for the baby potit or if neuros signs in front of pre-eclampsia for the mother potitis"},{"idx":3,"correct":false,"proposition":"Central antihypertensive","justification":""},{"idx":4,"correct":false,"proposition":"Low-dose aspirin","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-12-qi-11","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"After 24 hours of hospitalization, the patient's condition deteriorates. Blood pressure is now measured at 150\/100 mmHg. The patient complains of headache and epigastric pain. His diuresis is quantified at 200 ml since his hospitalization. The reflexes are sharp, diffused and polykinetic. Cardiofetal monitoring is not very oscillating with decelerations. You perform an emergency biological assessment, the results are as follows: platelets 60 G \/ L, hemoglobin 9 g \/ dL, schizocytes positive, haptoglobin 0.2 g \/ l, asat 230 IU \/ L, ALAT 340 IU \/ L. What are the priority therapeutic measures (one or more exact answers)? ","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Second injection of corticosteroids","justification":""},{"idx":1,"correct":true,"proposition":"Prevention of eclampsia by magnesium sulfate","justification":""},{"idx":2,"correct":true,"proposition":"Fetal extraction","justification":"This is an absolute emergency"},{"idx":3,"correct":false,"proposition":"Transfusion of red blood cells","justification":""},{"idx":4,"correct":false,"proposition":"Intravenous antihypertensive","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-12-qi-12","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"An emergency caesarean section is performed. The patient gives birth to a 1020 g girl cared for by the neonatal team. Breastfeeding is maternal. At 72 hours, maternal progress is satisfactory. High blood pressure has disappeared, as have headaches. Osteotendinous reflexes have normalized. Diuresis resumed normally. Maternal work-up also improved in the first 48 hours after delivery with the disappearance of HELLP syndrome. On day 4, the patient presents with fever at 38.5°C and significant hypogastric pelvic pain. His blood pressure is 130\/70 mmHg and his pulse is 90 bpm. Examination with the speculum reveals smelly lochia mixed with blood in small quantities. The caesarean section scar is clean. The breasts are tense, painful as a whole, without inflammatory cupboard or palpable mass. There is no axillary lymphadenopathy. The patient has not had a venous route or urinary catheter for 48 hours. No preventive anticoagulant therapy was initially initiated due to HELLP syndrome. What is the diagnosis you mention first? ","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Salpingitis","justification":""},{"idx":1,"correct":false,"proposition":"Pelvic abscess","justification":""},{"idx":2,"correct":true,"proposition":"Endometritis","justification":""},{"idx":3,"correct":false,"proposition":"Pelvic thrombophlebitis","justification":""},{"idx":4,"correct":false,"proposition":"Following an intraoperative perforation","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-12-qi-13","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"You perform a pelvic ultrasound in front of this suspicion of endometritis. A small placental retention measured 15 mm in sagittal section of the uterus is observed. What is (are) the element(s) of your therapeutic management? ","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Ceftriaxone and intravenous metronidazole","justification":"It's augmentin now (new reco 2021)"},{"idx":1,"correct":true,"proposition":"Endouterine aspiration in the operating room","justification":""},{"idx":2,"correct":false,"proposition":"Stopping breastfeeding","justification":""},{"idx":3,"correct":false,"proposition":"Methotrexate","justification":""},{"idx":4,"correct":true,"proposition":"Low molecular weight heparin at prophylactic dose","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-12-qi-14","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"Three days after starting treatment with antibiotics and heparin therapy at a prophylactic dose, pelvic pain persists, as does fever. The patient is still bloated. You request a CT scan with contrast injection. What is the most likely diagnosis?","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Textiloma"},{"idx":1,"correct":false,"proposition":"Urolithiasis enclosed in the lower right ureter","justification":""},{"idx":2,"correct":false,"proposition":"Acute appendicitis"},{"idx":3,"correct":true,"proposition":"Thrombosis of the right ovarian vein","justification":""},{"idx":4,"correct":false,"proposition":"Left pelvic abscess"}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-12-qi-15","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"In addition to the patient's personal and family thrombotic history, what additional risk factor(s) do you identify in this context of right ovarian vein thrombosis?","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Primiparity","justification":""},{"idx":1,"correct":false,"proposition":"The context of prematurity","justification":""},{"idx":2,"correct":true,"proposition":"The patient's body mass index","justification":""},{"idx":3,"correct":true,"proposition":"Caesarean section","justification":""},{"idx":4,"correct":true,"proposition":"Postpartum endometritis","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-12-qi-16","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"Knowing that serum creatinine is controlled at 70 micromol \/ L and that the patient wishes to continue breastfeeding, what is your anticoagulant prescription for this thrombophlebitis of the right ovarian vein ","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Fluindione","justification":""},{"idx":1,"correct":false,"proposition":"Acenochocoumarol","justification":""},{"idx":2,"correct":false,"proposition":"Warfarin","justification":""},{"idx":3,"correct":true,"proposition":"Enoxaparin at a hypocoagulant dose","justification":"LMWH then AVK relay"},{"idx":4,"correct":false,"proposition":"Cellar filter","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-14-qi-1","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"In view of the context, which diagnosis is to be mentioned in the first intention? ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Bladder lithiasis","justification":""},{"idx":1,"correct":true,"proposition":"Cystitis","justification":""},{"idx":2,"correct":false,"proposition":"Pyelonephritis","justification":""},{"idx":3,"correct":false,"proposition":"Renal tumour","justification":""},{"idx":4,"correct":false,"proposition":"Urothelial tumour","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-14-qi-2","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"What is (are) the element(s) to be collected during the interrogation in this context of discovery of hematuria? (one or more true propositions) ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"History of gross hematuria","justification":""},{"idx":1,"correct":true,"proposition":"Presence of proteinuria on the strip","justification":""},{"idx":2,"correct":false,"proposition":"Exposure to lead","justification":"No report"},{"idx":3,"correct":true,"proposition":"Family history of hematuria","justification":""},{"idx":4,"correct":false,"proposition":"Family history of bladder cancer","justification":"We do not start at all on a bladder cancer, which is not a hereditary pathology"}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-14-qi-3","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"The ECBU you prescribed to the patient currently finds: red blood cells 150,000\/ml; leukocytes< 1,000\/ml, sterile culture. There was a proteinuria with 2 crosses to the strip but the urine was concentrated. Her blood pressure is currently at 150\/90 mmHg in your consulting room. Her urinary beta-HCG is negative (the last menstrual period started 8 days ago). What biological examination(s) do you prescribe for this patient at this stage: (one or more expected proposals) ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Serum creatinine with glomerular filtration rate calculation","justification":""},{"idx":1,"correct":true,"proposition":"Proteinuria and creatinineuria on urine specimen","justification":""},{"idx":2,"correct":false,"proposition":"Crystalluria","justification":""},{"idx":3,"correct":false,"proposition":"Urinary cytology","justification":""},{"idx":4,"correct":false,"proposition":"Urinary pH","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-14-qi-4","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"What imaging test(s) do you prescribe for this patient at this stage? ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Uroscanner ","justification":""},{"idx":1,"correct":false,"proposition":"Endovaginal pelvic ultrasound","justification":""},{"idx":2,"correct":true,"proposition":"Renal and bladder ultrasound","justification":""},{"idx":2,"correct":false,"proposition":"uro-MRI","justification":""},{"idx":2,"correct":false,"proposition":"Retrograde cystography and voiding","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-14-qi-5","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"What is the action to take in the face of the discovery of this high blood pressure in this patient? (One or more correct answers) ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Prescription of amlodipine pending the results of biological tests","justification":""},{"idx":1,"correct":true,"proposition":"Request for outpatient self-measurement of blood pressure measurements","justification":""},{"idx":2,"correct":false,"proposition":"Prescription of an anxiolytic","justification":""},{"idx":3,"correct":false,"proposition":"Need to see the patient again within 48 hours for blood pressure control","justification":""},{"idx":4,"correct":true,"proposition":"Reassessment of blood pressure after discontinuation of ibuprofen","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-14-qi-6","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"The results of the prescribed examinations are as follows: Na 142 mmol\/L; K 4 mmol\/L, 2); proteinuria 2.5 g\/24 h, selective; serum creatinine 90 μmol\/L (DFG CKD-EPI at 71 mL\/min\/1.73 m^2 ECBU red blood cells 200,000\/mL, leukocytes< 1,000\/ml. Renal ultrasound finds kidneys of 118 mm and 122 mm respectively on the right and left with a cyst of the upper right pole of 1 cm. They are well differentiated, the cortical thickness is 22 mm, homogeneous. His ambulatory blood pressure is 150\/90 mmHg on average despite stopping ibuprofen. She describes asthenia and a recent loss of her hair that she links to strong tensions at work. You refer the patient to a nephrologist with other laboratory tests. Which examination(s) is the most relevant exam(s) given the context in this patient?","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"NFS, platelets","justification":""},{"idx":1,"correct":true,"proposition":"Plasma protein immunoelectrophoresis","justification":""},{"idx":2,"correct":false,"proposition":"Determination of parathyroid hormone and 250H vitamin D","justification":""},{"idx":3,"correct":true,"proposition":"Anti-nuclear factors, anti-DNA antibodies","justification":""},{"idx":4,"correct":true,"proposition":"Dosage C3, C4, CH50","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-14-qi-7","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"Your additional assessment is as follows: leukocytes 3.50 G \/ L, Hb 9 g \/ dL, VGM 92 fi; e platelets 200 G\/L, reticulocytes 250 G\/L, anti-nuclear factors positive at 1\/160 with native anti-DNA antibodies at 40 Ul\/ml, C3 0.5 g\/L (0.8-1.6); C4 0.08 g\/L (0.17-0.53), CH50 40 50 CRP 7 mg\/L; HCV and HIV negative serologies; HBV serology: anti-HBs 100 Ul\/ml antibodies, negative anti-HBc antibodies. What is (are) in favor of a diagnosis of systemic lupus? ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Leukopenia","justification":""},{"idx":1,"correct":true,"proposition":"Consumption of the supplement","justification":""},{"idx":2,"correct":true,"proposition":"Regenerative anemia","justification":""},{"idx":3,"correct":false,"proposition":"Inflammatory syndrome","justification":""},{"idx":4,"correct":true,"proposition":"Microscopic hematuria","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-14-qi-8","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"What are the possible causes of this anemia in this context (one or more correct answers)? ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Chronic renal failure","justification":""},{"idx":1,"correct":false,"proposition":"Immunological thrombocytopenic purpura","justification":""},{"idx":2,"correct":true,"proposition":"Coombs-positive hemolytic anemia","justification":""},{"idx":3,"correct":false,"proposition":"Thrombotic microangiopathy","justification":""},{"idx":4,"correct":true,"proposition":"Acute gynecological bleeding","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-14-qi-9","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"What extrarenal clinical signs will you look for in the context of this probable lupus flare-up? (One or more correct answers) ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Mouth ulcers","justification":""},{"idx":1,"correct":true,"proposition":"Erythema nodosum","justification":""},{"idx":2,"correct":true,"proposition":"Polyarthritis","justification":""},{"idx":3,"correct":false,"proposition":"Scleroditactyly","justification":""},{"idx":4,"correct":true,"proposition":"Vulvar ulcerations","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-14-qi-10","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"The patient has non-erosive mouth ulcers and arthritis of the hands and you are diagnosed with systemic lupus. What is the most appropriate course of action for this patient at this stage? (Only one response is expected.) ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Biological monitoring as a first step","justification":""},{"idx":1,"correct":true,"proposition":"Performing a transparietal renal biopsy puncture","justification":""},{"idx":2,"correct":false,"proposition":"Realization of a uroscanner","justification":""},{"idx":3,"correct":false,"proposition":"Performing a renal angiography","justification":""},{"idx":4,"correct":false,"proposition":"No need for renal histological confirmation in this context of leupic nephropathy","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-14-qi-11","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"You decide to perform a kidney biopsy on this patient. She is hospitalized in nephrology. His clinical examination regained a blood pressure of 155\/90 mmHg. She is apyretic but has had voiding burns for 48 hours. Its biological balance finds: leukocytes 3.8 G \/ L, Hb 9.4 g \/ dL, VGM 88 fL, platelets 220 G \/ L, Na 142 mmol \/ L, K 3.7 mmol \/ L; 2 ); serum creatinine 99 μmol\/L (glomerular filtration rate CKD-EPI at 63 ml\/min\/1.73 m^2 proteinuria 2.2 g\/24 h, selective; ECBU red blood cells 300,000\/ml; leukocytes 20,000\/ml; many live Gram-negative bacilli. You decide to treat 48 hours this probable cystitis before performing the renal biopsy puncture and normalizing his blood pressure. What are the elements of your therapeutic care? (One or more correct answers) ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Treatment with metronidazole","justification":""},{"idx":1,"correct":false,"proposition":"Treatment with single-dose ofloxacin","justification":""},{"idx":2,"correct":false,"proposition":"Amoxicillin treatment","justification":""},{"idx":3,"correct":true,"proposition":"Treatment with fosfomycin-trometamol","justification":""},{"idx":4,"correct":false,"proposition":"Treatment with gentamicin","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-14-qi-12","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"What are the possible basic histological elements in this patient given her clinicobiological presentation? (One or more correct answers) ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Dominant mesangial deposits of immunoglobulin A and complement","justification":""},{"idx":1,"correct":true,"proposition":"Extra-capillary proliferation","justification":""},{"idx":2,"correct":true,"proposition":"Endocapillary proliferation","justification":""},{"idx":3,"correct":true,"proposition":"Extramembranous immunoglobulin and complement deposits in immunofluorescence","justification":""},{"idx":4,"correct":false,"proposition":"Glomerular deposits of dominant C3","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-14-qi-13","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"Here is the report of your patient's renal biopsy: 8 mm renal cortical fragment containing 15 glomeruli including 1 sealing loaf; Optical microscopy: 10 glomeruli out of 15 are the site of endocapillary proliferation, presence of extra-capillary proliferations on 3 glomeruli, voluminous endomembranous deposits along the glomerular capillaries making << wireloops >>; - polymorphic interstitial infiltrate on about 30% of the cortical surface; - no vascular lesions or tubular lesions, presence of haematic cylinders in some tubular lumen; - immunofluorescence:  granular deposits of Ig G, lgM, C3 and C1q to 3+ mesangial and 2+ endomembranous on all glomeruli, no extramembranous deposits, fibrin deposits on 4 out of 18 glomeruli. What is your diagnosis?","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Extramembranous lupus glomerulonephritis","justification":""},{"idx":1,"correct":false,"proposition":"Pure mesangial lupus glomerulonephritis","justification":""},{"idx":2,"correct":true,"proposition":"Diffuse proliferative lupus glomerulonephritis","justification":""},{"idx":3,"correct":false,"proposition":"Tubulointerstitial lupus nephritis","justification":""},{"idx":4,"correct":false,"proposition":"Focal proliferative lupus glomerulonephritis","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-14-qi-14","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"Your patient therefore has a systemic lupus flare-up with hemolytic anemia, polyarthritis, canker sores, alopecia and class IV lupus glomerulonephritis (diffuse proliferative). What are the treatment options for attack therapy in this patient? (One or more correct answers) ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"A course of infliximab","justification":"It's an alpha anti-TNF, nothing to see"},{"idx":1,"correct":false,"proposition":"A course of rituximab","justification":"It's an anti-CD20, nothing to see"},{"idx":2,"correct":true,"proposition":"bolus of methylprednisolone then prednisone 1 mg\/kg","justification":""},{"idx":3,"correct":true,"proposition":"mycophenolate mofetil","justification":""},{"idx":4,"correct":true,"proposition":"cyclophosphamide","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-14-qi-15","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"You start the attack treatment which is well tolerated including corticosteroid therapy in high doses. His blood pressure is 145\/90 mmHg on ramipril that you started before the kidney biopsy. His renal assessment before discharge is as follows: serum creatinine 97 μmol \/ L (filtration rate 2 glomerular CKD-EPI at 65 ml \/ min \/ 1.73 m ^ 2 ), proteinuria 2.2 g \/ 24 h; ECBU red blood cells 350000\/ml. What are the different possible therapeutic measures before returning home? (one or more correct answers) ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Amlodipine in combination with ramipril","justification":""},{"idx":1,"correct":true,"proposition":"Hydroxychloroquine","justification":""},{"idx":2,"correct":true,"proposition":"Cholecalciferol","justification":""},{"idx":3,"correct":true,"proposition":"Hydrochlorothiazide in combination with ramipril","justification":""},{"idx":4,"correct":false,"proposition":"Candesartan in combination with ramipril","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-15-qi-1","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"What are you looking for in interrogation to explore this anomaly? (One or more correct answers)","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Recent extended stay at altitude","justification":""},{"idx":1,"correct":true,"proposition":"Tobacco use"},{"idx":2,"correct":true,"proposition":"Alcohol consumption"},{"idx":3,"correct":true,"proposition":"Recent fever"},{"idx":4,"correct":true,"proposition":"Recent weight gain"}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-15-qi-2","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"On clinical examination, what signs would point you to primary polycythemia? (one or more possible answers) ","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Palar erythrosis","justification":""},{"idx":1,"correct":true,"proposition":"Aquagenic pruritus","justification":""},{"idx":2,"correct":false,"proposition":"Conjunctival hyperemia","justification":""},{"idx":3,"correct":false,"proposition":"Exertional dyspnea","justification":""},{"idx":4,"correct":false,"proposition":"Splenomegaly","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-15-qi-3","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"You make a blood count that shows: GR 6.9 T\/L; haemoglobin 18.7 g\/dL, haematocrit 57%; MCV 83 fL, MCHC 33 g\/dL, reticulocytes 80 G\/L, leukocytes 12.6 G\/L, neutrophils 10.4 G\/L, eosinophil polynuclear 0.3 G\/L, basophilic polynuclear 0.05 G\/L, lymphocytes 1.25 G\/L, monocytes 0.6 G\/L, platelets 534 G\/L. What does this blood count show? (one or more possible answers)","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Polycythemia","justification":""},{"idx":1,"correct":false,"proposition":"Hyperreticulocytosis","justification":""},{"idx":2,"correct":false,"proposition":"Hyperchromia","justification":""},{"idx":3,"correct":false,"proposition":"Microcytosis","justification":""},{"idx":4,"correct":true,"proposition":"Thrombocytosis","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-15-qi-4","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"You find on examination a splenomegaly with a costal overhang of 2 cm and the notion of aquagenic pruritus. Which of the following tests are useful in this patient to support the diagnosis of polycythemia vera (one or more answers are possible)?","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Erythropoietin Dosage","justification":""},{"idx":1,"correct":false,"proposition":"Myelogram","justification":""},{"idx":2,"correct":true,"proposition":"JAK2 mutation search","justification":""},{"idx":3,"correct":false,"proposition":"Culture of erythroid progenitors","justification":""},{"idx":4,"correct":false,"proposition":"Isotopic globular mass","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-15-qi-5","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"You see the patient again with the results of your tests. He has a JAK2 mutation and erythropoietin levels are plummeted. The patient, worried, asks you about complications that may occur. What do you say to him (One or more possible answers here)?","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Venous thrombosis","justification":""},{"idx":1,"correct":true,"proposition":"Arterial thrombosis","justification":""},{"idx":2,"correct":false,"proposition":"Lysis syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Disseminated intravascular coagulation","justification":""},{"idx":4,"correct":true,"proposition":"Gout attack","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-15-qi-6","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"About polycythemia vera, which propositions are true? (One or more possible answers)","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"It is a clonal disease of mature hematopoietic cells","justification":""},{"idx":1,"correct":true,"proposition":"This is a myeloproliferative syndrome","justification":""},{"idx":2,"correct":false,"proposition":"There is an erythroblastic maturation blockade","justification":""},{"idx":3,"correct":false,"proposition":"Circulating erythroblasts are observed","justification":""},{"idx":4,"correct":true,"proposition":"There is spontaneous growth of erythroblastic progenitors in vitro","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-15-qi-7","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"The patient asks you about the principles of treatment. What kind of care do you discuss with him? (One or more correct answers) ","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":" Bleedings","justification":""},{"idx":1,"correct":true,"proposition":"Acetyl-salicylic acid","justification":""},{"idx":2,"correct":false,"proposition":"Anticoagulants","justification":""},{"idx":3,"correct":false,"proposition":"Mdt","justification":""},{"idx":4,"correct":false,"proposition":"Repeated blood donations at EFS","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-15-qi-8","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"The patient had initial bleeding and is currently on antiaggregants. Three months later, your patient comes to see you 48 hours after returning from vacation in the West Indies. He has a painful left calf that has been swollen for 24 hours. What clinical elements will support your suspicion of deep vein thrombosis (phlebitis)? (One or more possible answers) ","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Calf pressure pain","justification":""},{"idx":1,"correct":true,"proposition":"Increased calf circumference","justification":""},{"idx":2,"correct":false,"proposition":"Calf contracture","justification":""},{"idx":3,"correct":false,"proposition":"Decreased pediosus pulse","justification":""},{"idx":4,"correct":true,"proposition":"Dilation of superficial veins","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-15-qi-9","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"What are the risk factors for phlebitis in this patient? (One or more correct answers)","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Obesity","justification":""},{"idx":1,"correct":false,"proposition":"Long-term antiplatelet agent","justification":""},{"idx":2,"correct":false,"proposition":"High blood pressure (hypertension)","justification":""},{"idx":3,"correct":false,"proposition":"Hypercholesterolemia","justification":""},{"idx":4,"correct":true,"proposition":"Air travel","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-15-qi-10","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"The clinical examination is not very specific. Which tests are useful for diagnosis? (One or more possible answers)","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Pulmonary angiography","justification":""},{"idx":1,"correct":true,"proposition":"Doppler ultrasound of the lower limbs","justification":""},{"idx":2,"correct":false,"proposition":"Phlebography of the lower limbs","justification":""},{"idx":3,"correct":false,"proposition":"TP, TCA, fibrin","justification":""},{"idx":4,"correct":false,"proposition":"Search for protein C and S deficiency","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-15-qi-11","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"Doppler ultrasound confirmed the existence of sural phlebitis. What therapeutic attitudes are possible in this patient? (One or more possible answers) ","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Direct oral anticoagulants","justification":""},{"idx":1,"correct":false,"proposition":"Acetylsalicylic acid and clopidogrel","justification":""},{"idx":2,"correct":true,"proposition":"Low molecular weight heparin","justification":""},{"idx":3,"correct":false,"proposition":"Strict bed rest","justification":""},{"idx":4,"correct":true,"proposition":"Venous compression","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-15-qi-12","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"You have opted for LMWH treatment with early relay with vitamin K antagonist (warfarin). What recommendations do you give your patient in relation to this treatment? (one or more possible answers) ","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Wearing a card mentioning the treatment on oneself","justification":""},{"idx":1,"correct":true,"proposition":"Taking warfarin at a fixed time","justification":""},{"idx":2,"correct":false,"proposition":"Follow a strict diet","justification":"This is not a strict diet: just avoid a few foods that interfere with hepatic enzyme metabolism."},{"idx":3,"correct":false,"proposition":"Strict cessation of alcohol consumption","justification":""},{"idx":4,"correct":true,"proposition":"Prohibition of intramuscular injections","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-15-qi-13","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"During his follow-up, the patient calls you because his control INR is 5.5. He found no bleeding signs. What do you do? ","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"You hospitalize him","justification":""},{"idx":1,"correct":true,"proposition":"You ask him to skip a catch","justification":""},{"idx":2,"correct":false,"proposition":"You prescribe vitamin K orally","justification":""},{"idx":3,"correct":false,"proposition":"You prescribe protamine sulfate","justification":""},{"idx":4,"correct":true,"proposition":"You recheck the INR the next day","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-15-qi-14","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"Your patient has been transferred to a city 500 km from your home. You have no news for several years. Then, a doctor who sees him for the first time calls you because the patient is referred to him for discomfort. The blood count shows: Hb 10 g\/dL, MCV 83 fL, leukocytes 3 G\/L, PNN 0.8 G\/L, lymphocytes 1 G\/L, monocytes 0.2 G\/L, blast cells 1 G\/L, platelets 86 G\/L. What abnormalities do you see on this blood count? (One or more correct answers) ","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Neutropenia","justification":""},{"idx":1,"correct":true,"proposition":"Thrombocytopenia","justification":""},{"idx":2,"correct":false,"proposition":"Balanced myelemia","justification":""},{"idx":3,"correct":true,"proposition":"Pancytopenia","justification":""},{"idx":4,"correct":false,"proposition":"Microcytic anemia","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-15-qi-15","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"What diagnoses do you mention in this context? (One or more possible answers) ","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Transformation into acute leukemia","justification":""},{"idx":1,"correct":false,"proposition":"Progression to myelofibrosis","justification":""},{"idx":2,"correct":false,"proposition":"Syndrome de Richter","justification":""},{"idx":3,"correct":false,"proposition":"Transformation into chronic myelogenous leukemia","justification":""},{"idx":4,"correct":false,"proposition":"Progression to myeloid splenomegaly","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-16-qi-1","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"The nurse on the unit gives you the following information: blood pressure at 95\/55mmHg, temperature at 39°C and heart rate at 110\/min. Dyspnea is in the foreground. On pulmonary auscultation, you find a decrease in the vesicular murmur of the base of the left lung. Which of the following proposals is (are) the element(s) in favor of pleural effusion in this patient?","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Noise added to left one-sided crackling type","justification":""},{"idx":1,"correct":true,"proposition":"Dull percussion at the left base","justification":""},{"idx":2,"correct":false,"proposition":"Increased vocal vibration","justification":""},{"idx":3,"correct":false,"proposition":"Noise added to expiratory sibilant type","justification":""},{"idx":4,"correct":false,"proposition":"Chest distension","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-16-qi-2","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"You get more information for this patient who lives alone at home independently. He has a history of NYHA stage III heart failure on ischemic and hypertensive heart disease. The nurse had her daughter on the phone telling her that her father has not been elected as usual for 48 hours, with incoherent words. \nAt careful pulmonary auscultation, you find noises added to type of unilateral crackles in the left base. Vocal vibrations are increased in the left base. He has no signs of right heart failure. \nWhich of the following is the most likely etiology(s) of the pulmonary picture? (one or more exact propositions)","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Acute pericarditis"},{"idx":1,"correct":false,"proposition":"Pulmonary embolism"},{"idx":2,"correct":true,"proposition":"Community-acquired bacterial pneumonia","justification":""},{"idx":3,"correct":false,"proposition":"Pneumothorax"},{"idx":4,"correct":true,"proposition":"Community-acquired viral pneumonia","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-16-qi-3","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"To assess the seriousness of this patient, which element seems most important?","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Looking for a sign of neurological focus","justification":""},{"idx":1,"correct":false,"proposition":"Purpura search","justification":""},{"idx":2,"correct":true,"proposition":"Respiratory rate measurement","justification":""},{"idx":3,"correct":false,"proposition":"Diuresis measurement","justification":""},{"idx":4,"correct":false,"proposition":"Search for a paradoxical pulse","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-16-qi-4","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"The patient has a respiratory rate of 35\/min and his saturation is measured at 94% in ambient air. You suspect acute lobar pneumonia. Which of the following additional examinations should be carried out immediately? (one or more exact propositions)","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Blood gas","justification":""},{"idx":1,"correct":true,"proposition":"ECG","justification":""},{"idx":2,"correct":false,"proposition":"D-Dimers","justification":""},{"idx":3,"correct":true,"proposition":"X-ray of the front chest","justification":""},{"idx":4,"correct":true,"proposition":"Blood","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-16-qi-5","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"Biological samples are in progress and chest X-ray shows alveolar opacity of the left base associated with low pleural effusion. Arterial blood gases show: PaO 62 mmHg; PaCO 28 mmHg; lactate 1.3 mmol\/L; pH 7.46. Which of the following propositions in this patient is(s) the correct statement(s)? ","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"You immediately think of a pulmonary embolism","justification":""},{"idx":1,"correct":false,"proposition":"You think it's consistent with the diagnosis of pneumonia","justification":""},{"idx":2,"correct":false,"proposition":"You think the value of lactate points to acute community-acquired pneumonia","justification":""},{"idx":3,"correct":false,"proposition":"You think pleural effusion may explain the gasometric shunt effect","justification":""},{"idx":4,"correct":false,"proposition":"You suspect a sampling error","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-16-qi-6","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"Given the context of falling, you examine the musculoskeletal system. Your exam finds pain in your right hip. You suspect a fracture of the right femoral neck because there are: (one or more possible answers) ","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Functional impotence of the right lower limb","justification":""},{"idx":1,"correct":true,"proposition":"Pain on palpation of the right great trochanter","justification":""},{"idx":2,"correct":false,"proposition":"Internal rotation of the right hip","justification":""},{"idx":3,"correct":false,"proposition":"A psoitis on the right side","justification":""},{"idx":4,"correct":false,"proposition":"Shortening of the lower right limb","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-16-qi-7","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"The hip X-ray does not show a fracture of the femoral neck. The blood count shows leukocytes at 15 G\/L, hemoglobin at 10 g\/dL and platelets at 349 G\/L. The serum creatinine is 75 micromol\/L. What care do you start with this patient? ","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Nasal oxygen","justification":""},{"idx":1,"correct":true,"proposition":"Peripheral venous route","justification":""},{"idx":2,"correct":false,"proposition":"Intravenous ciprofloxacin","justification":""},{"idx":3,"correct":true,"proposition":"Low molecular weight heparin at preventive dose","justification":""},{"idx":4,"correct":false,"proposition":"Isotonic saline in venous infusion 3 liters \/ day","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-16-qi-8","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"Which of the following other measures is the most important to put in place? ","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Prevention of swallowing disorders","justification":""},{"idx":1,"correct":false,"proposition":"Prevention of dehydration","justification":""},{"idx":2,"correct":true,"proposition":"Pressure ulcer prevention","justification":"It is an early complication and carries great morbidity"},{"idx":3,"correct":false,"proposition":"Urinary catheter placement","justification":""},{"idx":4,"correct":false,"proposition":"Oral care","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-16-qi-9","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"During the first 24 hours of hospitalization, the patient has incoherent words. He believes he is in 1939. At times, on the contrary, it seems well suited. It is most often drowsy. When you enter the room, he does not remember seeing you in the morning and does not know that he is hospitalized. You mention a delirium syndrome. Which semiological element(s) present in the observation is (are) in favor of this diagnostic hypothesis? ","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Attentional disorders","justification":""},{"idx":1,"correct":true,"proposition":"Fluctuations in unrest","justification":""},{"idx":2,"correct":false,"proposition":"Phasia disorders","justification":""},{"idx":3,"correct":false,"proposition":"Memory disorder","justification":""},{"idx":4,"correct":false,"proposition":"Apathy","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-16-qi-10","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"The patient was put on oxygen and antibiotic therapy was started. The next morning the nurse finds that the patient is getting worse. What sign(s) would be in favor of hypercapnia? ","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"The presence of low blood pressure","justification":""},{"idx":1,"correct":false,"proposition":"The presence of ample dyspnea","justification":""},{"idx":2,"correct":true,"proposition":"Deepening confusion","justification":""},{"idx":3,"correct":true,"proposition":"The presence of sweat","justification":""},{"idx":4,"correct":true,"proposition":"An asterixis","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-16-qi-11","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"Finally, the patient evolves favorably on the respiratory plan in your 3 days with apyrexia and a reduction in respiratory rate. However, he has not eaten anything in the last 3 days and you fear the presence of protein-energy malnutrition (MPE). Which of the following proposals regarding its nutritional status is the right proposal(s)?","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"His nutritional status may not have deteriorated sufficiently in 3 days","justification":""},{"idx":1,"correct":false,"proposition":"The determination of blood albumin is essential to determine the nutritional status","justification":""},{"idx":2,"correct":false,"proposition":"Lack of power over the last 3 days can define an MPE","justification":""},{"idx":3,"correct":false,"proposition":"MPE can be defined according to HAS by weight loss over the past year","justification":""},{"idx":4,"correct":true,"proposition":"A body mass index < 21 kg\/m^2 defines MPE","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-16-qi-12","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"On the 4th day, your patient can get up but the bipodal support is painful preventing walking and the unipodal support on the right is impossible. A second hip X-ray is re-read normally. \nWhich of the following proposals regarding his condition is(s) the correct statement(s) at this stage? (one or more exact propositions)","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"You prescribe a bone scan","justification":""},{"idx":1,"correct":false,"proposition":"You suspect a simple bruise","justification":""},{"idx":2,"correct":true,"proposition":"You are looking for an ilio- or ischiopubic branch fracture","justification":""},{"idx":3,"correct":true,"proposition":"You prescribe a scanograhie of the pelvis and hips","justification":""},{"idx":4,"correct":false,"proposition":"You prescribe an X-ray of the right knee","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-16-qi-13","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"The CT scan revealed a fracture of the right iliopubic branch. The evolution is favorable under analgesic treatment and active early mobilization in one week. You plan to return home. What element(s) should be assessed before considering a return home?","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"ADL","justification":""},{"idx":1,"correct":true,"proposition":"IADL","justification":""},{"idx":2,"correct":false,"proposition":"MNA","justification":""},{"idx":3,"correct":true,"proposition":"Fried's criteria","justification":""},{"idx":4,"correct":false,"proposition":"Geriatric depression scale","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-16-qi-14","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"You have assessed their basic activities of daily living (ADL score). What element(s) constitutes this score? ","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"His ability to shop without help","justification":""},{"idx":1,"correct":false,"proposition":"Its ability to answer the phone without aids","justification":""},{"idx":2,"correct":false,"proposition":"Its ability to use public transport without aids","justification":""},{"idx":3,"correct":true,"proposition":"Its ability to eat without aids","justification":""},{"idx":4,"correct":false,"proposition":"Their ability to manage medications without aids","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-16-qi-15","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"You measure their current ADL (Basic Activities of Daily Living) score at 4\/6, and their iso-resource group (GIR) at 4. What is the correct interpretation(s)?","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"The ADL score shows that there is an addiction for one's instrumental activities of daily living","justification":""},{"idx":1,"correct":false,"proposition":"The GIR is associated with the ADL level","justification":"At the AGGIR grid"},{"idx":2,"correct":true,"proposition":"The ADL score does not measure the presence of a cognitive disorder","justification":""},{"idx":3,"correct":true,"proposition":"Cognitive impairment is taken into account in the measurement of the GIR","justification":""},{"idx":4,"correct":true,"proposition":"It seems likely that he will obtain financial assistance for his home helpers","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-17-qi-1","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"What semeiological element(s) are you looking for in favor of a cardiac cause of dyspnea in this patient? ","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Morning cough and sputum","justification":""},{"idx":1,"correct":false,"proposition":"Digital Hippocratism","justification":""},{"idx":2,"correct":false,"proposition":"Cough during exertion and decubitus","justification":""},{"idx":3,"correct":false,"proposition":"Gravity of the hypochondrium right to effort","justification":""},{"idx":4,"correct":false,"proposition":"Palpitations at the effrt","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-17-qi-2","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"The patient lives on the 38th floor with elevator. He does not present respiratory discomfort for everyday gestures. On the other hand, it signals dyspnea when walking uphill at normal speed (4 km \/ h). \nAt what stage of the NYHA does this description fit?","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"I"},{"idx":1,"correct":true,"proposition":"II"},{"idx":2,"correct":false,"proposition":"III"},{"idx":3,"correct":false,"proposition":"IV"},{"idx":4,"correct":false,"proposition":"Unclassifiable with available data","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-17-qi-3","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"The patient has NYHA stage II dyspnea. Cardiac auscultation reveals mitral insufficiency. On which auscultatory anomaly(ies) is this diagnosis based?","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Protodiastolic murmur","justification":""},{"idx":1,"correct":false,"proposition":"Mesosystolic strengthening breath","justification":""},{"idx":2,"correct":true,"proposition":"Holosystolic murmur","justification":""},{"idx":3,"correct":false,"proposition":"Raspy tone","justification":""},{"idx":4,"correct":false,"proposition":"Abolition of B1","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-17-qi-4","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"The general practitioner refers the patient to a cardiology consultation. While waiting for his appointment, the patient is admitted to the emergency room for acute dyspnea. The emergency physician evokes an acute edema of the lung (OAP) cardigenic. What is the main semeiological argument for this diagnosis?","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"oxygen desaturation (SpO2)"},{"idx":1,"correct":false,"proposition":"focus of crackling rales"},{"idx":2,"correct":true,"proposition":"Complete intolerance to supine position"},{"idx":3,"correct":false,"proposition":"chest tightness"},{"idx":4,"correct":false,"proposition":"jugular turgor","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-17-qi-5","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"The clinical examination finds bilateral crackling rales going back to mid-field. Routine laboratory tests (blood count, platelets, blood ionogram, urea and serum creatinine) have been taken and you are waiting for the results. What is (are) the additional examination(s) essential before starting treatment? ","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Electrocardiogram","justification":""},{"idx":1,"correct":false,"proposition":"Determination of BNP or NT-proBNP","justification":""},{"idx":2,"correct":false,"proposition":"Determination of D-dimer","justification":""},{"idx":3,"correct":false,"proposition":"Pulmonary angio-CT","justification":""},{"idx":4,"correct":false,"proposition":"Echocardiography","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-17-qi-6","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"A chest X-ray is performed. What abnormality(s) present on this picture is (are) in favor of the diagnosis of heart failure?","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Cardiomegaly"},{"idx":1,"correct":true,"proposition":"Right pleural effusion"},{"idx":2,"correct":false,"proposition":"Vascular redistribution at the bases","justification":""},{"idx":3,"correct":true,"proposition":"Kerley Lines"},{"idx":4,"correct":false,"proposition":"Pericardial effusion"}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-17-qi-7","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"The electrocardiogram does not show an argument in favor of an acute coronary syndrome. The presence of orthopnea, diffuse subcrackling rales halfway up the pulmonary fields with bilateral radiological alveolar syndrome was sufficient for the diagnosis of acute pulmonary edema. Blood pressure is at 140\/90 mmHg, heart rate is at 110 beats\/min, there is no mottling or cooling of the extremities. Treatment with furosemide and oxygen therapy are started. Which complementary treatment(s) should be prescribed urgently? ","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Nitrates by intravenous infusion with an electric syringe","justification":""},{"idx":1,"correct":false,"proposition":"Dobutamine intravenous infusion with an electric syringe","justification":""},{"idx":2,"correct":false,"proposition":"Bisoprolol orally in small doses","justification":""},{"idx":3,"correct":false,"proposition":"Unfractionated intravenous heparin for 2.5x control ACT","justification":""},{"idx":4,"correct":false,"proposition":"Isotonic salted serum infusion 1 Uj","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-17-qi-8","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"The response to treatment is quickly favorable. An electrocardiogram is recorded again. What is the interpretation of this electrocardiogram?","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Normal electrocardiogram"},{"idx":1,"correct":true,"proposition":"Sequelae of myocardial infarction","justification":""},{"idx":2,"correct":false,"proposition":"Full right branch block","justification":""},{"idx":3,"correct":true,"proposition":"Sinus rhythm"},{"idx":4,"correct":false,"proposition":"Left posterior hemibloc (fascicular block)","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-17-qi-9","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"An echocardiogram is performed with the following results: - dilation of the left ventricle with alteration of the ejection fraction to 30%; - Akinesia of the lower wall with hypokinesia of the lateral wall of the left ventricle; - dilation of the left atrium and right ventricle; - elevation of the filling pressures of the left ventricle; - moderate mitral leakage (grade II) of restrictive mechanism associated with dilation of the mitral ring. Systolic pulmonary arterial pressure is estimated to be elevated. What is (are) the contribution(s) of this echocardiography concerning the diagnosis?","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Mitral insufficiency is ischemic","justification":""},{"idx":1,"correct":true,"proposition":"The patient presented with an unnoticed myocardial infarction","justification":""},{"idx":2,"correct":true,"proposition":"The current picture of heart failure is due to ischemic heart disease","justification":""},{"idx":3,"correct":false,"proposition":"The current picture of heart failure is valvular cause","justification":""},{"idx":4,"correct":false,"proposition":"The patient developed pulmonary embolism","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-17-qi-10","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"It is an ischemic heart disease with mitral leakage secondary to an unnoticed inferior myocardial infarction, complicated by heart failure with impaired ejection fraction. Which of the following decisions is, at this stage, the most important for this patient? ","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Confirmation of pulmonary hypertension by right catheterization","justification":""},{"idx":1,"correct":true,"proposition":"Search for viability and myocardial ischemia of the left ventricle","justification":""},{"idx":2,"correct":false,"proposition":"Analysis of the possibility of mitral plasty surgery","justification":""},{"idx":3,"correct":false,"proposition":"Pre-heart transplant assessment","justification":""},{"idx":4,"correct":false,"proposition":"Metabolic stress test (with gas analysis and V02 calculation)","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-17-qi-11","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"The search for myocardial ischemia is positive in the anteroseptal territory and leads to the realization of a coronary angiography. This examination reveals critical stenosis of the anterior interventricular coronary artery that is treated by angioplasty (percutaneous coronary intervention) and placement of a stent (stent). \nWhat is (are) the therapeutic adaptation(s) to be made before returning home?","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Introduce a bradycardial calcium channel blocker (diltiazem or verapamil)","justification":""},{"idx":1,"correct":false,"proposition":"Initiate triple antithrombotic therapy (e.g. aspirin+apixaban+clopidogrel)","justification":""},{"idx":2,"correct":false,"proposition":"Combine ezetimibe with rosuvastatin","justification":""},{"idx":3,"correct":true,"proposition":"Introduce a beta oral blocker in progressive doses","justification":""},{"idx":4,"correct":true,"proposition":"Prescribe cardiac rehabilitation","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-17-qi-12","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"The patient discharges the hospital with carvedilol, enalapril, aspirin, prasugrel, rosuvastatin, furosemide, potassium salts and metformin. It is reviewed periodically to gradually increase the doses of carvedilol and enalapril to the target doses. Four months after revascularization, he is still dyspneic on exertion at NYHA stage II. He describes a first episode of brief loss of consciousness when climbing stairs, 30 minutes after taking his treatment. The search for orthostatic arterial hypotension is negative. The electrocardiogram is not changed. Echocardiography shows the persistence of systolic dysfunction with a stationary left ventricle ejection fraction at 30%, mitral leakage has not evolved and remains moderate (grade II). What is (are) the therapeutic adaptation(s) to be made to manage heart failure and its consequences? ","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Introduce a mineralocorticoid receptor antagonist","justification":""},{"idx":1,"correct":false,"proposition":"Implant a defibrillator","justification":""},{"idx":2,"correct":false,"proposition":"Reduce the dosages of enalapril and carvedilol","justification":""},{"idx":3,"correct":false,"proposition":"Implement ventricular resynchronization by biventricular stimulator","justification":""},{"idx":4,"correct":false,"proposition":"Prohibit excessive alcohol consumption","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-17-qi-13","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"A few months later the patient presents a brutal, intense pain in the lower right limb which wakes him up at 6 am. He consults you at noon. The pain is intolerable agitating the patient, the foot is livid and cold with functional impotence. You will only find the femoral pulse in the right lower limb. You observe a discrete bilateral perimalleolar edema, taking the bucket. Skin sensitivity is decreased on the right side of the knee to the foot. Palpation of the calf is painful. What is the diagnosis to evoke in this patient? ","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Gout attack","justification":""},{"idx":1,"correct":false,"proposition":"Deep vein thrombosis of the lower limb","justification":""},{"idx":2,"correct":false,"proposition":"Paralyzing sciatica","justification":""},{"idx":3,"correct":false,"proposition":"Cholesterol crystal embolism","justification":""},{"idx":4,"correct":true,"proposition":"Acute ischemia of the lower limb","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-17-qi-14","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"In front of this brutal clinical picture you retain the occurrence of acute limb ischemia. What is (are) the sign(s) of gravity?","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"The presence of edema"},{"idx":1,"correct":true,"proposition":"The presence of a sensory and motor deficit","justification":""},{"idx":2,"correct":true,"proposition":"Pain at the pressure of muscle masses","justification":""},{"idx":3,"correct":true,"proposition":"A long delay in handling","justification":""},{"idx":4,"correct":true,"proposition":"The level of arterial obstruction","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-17-qi-15","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"What additional diagnostic examination do you propose to this patient before entrusting him to the surgical team? ","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"No further examination","justification":""},{"idx":1,"correct":false,"proposition":"CT angiography (CT scan)","justification":""},{"idx":2,"correct":false,"proposition":"Arteriography","justification":""},{"idx":3,"correct":false,"proposition":"MRI angiography","justification":""},{"idx":4,"correct":false,"proposition":"Ultrasound-Doppler","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-17-qi-16","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"The surgical team will immediately take care of the patient to perform emergency revascularization. What is (are) the modality(s) of care to be put in place immediately?","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Lower limb elevation","justification":"This will further decrease the arterial influx. On the contrary, they must be put in the unslid position."},{"idx":1,"correct":true,"proposition":"Unfractionated heparin with an electric syringe after an intravenous bolus","justification":""},{"idx":2,"correct":true,"proposition":"Stage 3 analgesic","justification":""},{"idx":3,"correct":true,"proposition":"Protection of the limb by avoiding compression points","justification":""},{"idx":4,"correct":true,"proposition":"Intravenous arterial vasodilator therapy","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-17-qi-17","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"What risk(s) is (s) to which the patient is exposed due to the occurrence of this acute ischemia? ","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Hypokalemia","justification":""},{"idx":1,"correct":true,"proposition":"Metabolic acidosis","justification":""},{"idx":2,"correct":true,"proposition":"Acute renal failure","justification":""},{"idx":3,"correct":true,"proposition":"Heart rhythm disorders","justification":""},{"idx":4,"correct":false,"proposition":"Acute liver failure","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-18-qi-1","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"What are the diagnoses to evoke in front of dysphonia (one or more expected responses) in this patient? ","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Polyp of vocal folds (vocal cords)","justification":""},{"idx":1,"correct":false,"proposition":"Intracordal nodule","justification":""},{"idx":2,"correct":true,"proposition":"Cancer of the vocal folds (vocal cords)","justification":""},{"idx":3,"correct":true,"proposition":"Unilateral laryngeal immobility","justification":""},{"idx":4,"correct":false,"proposition":"Oropharyngeal cancer","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-18-qi-2","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"Which of the following risk factors promote the development of vocal fold cancer (one or more expected responses)?","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Isolated ethyl poisoning","justification":""},{"idx":1,"correct":true,"proposition":"Alcohol and tobacco poisoning","justification":""},{"idx":2,"correct":true,"proposition":"Isolated tobacco poisoning","justification":""},{"idx":3,"correct":false,"proposition":"Infection à Hu man Papilloma Virus","justification":""},{"idx":4,"correct":false,"proposition":"Infection à Epstein Barr Virus","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-18-qi-3","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"The patient is seen in consultation with 0RL. Among the following tests, which are those that make it possible to evoke the diagnosis of laryngeal cancer during a 0RL consultation (one or more expected answers):","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Acoustic voice analysis","justification":""},{"idx":1,"correct":true,"proposition":"Laryngeal fibroscopy","justification":""},{"idx":2,"correct":true,"proposition":"Indirect LaryngoscoP.ie","justification":""},{"idx":3,"correct":false,"proposition":"Laryngeal videostroboscopy","justification":""},{"idx":4,"correct":false,"proposition":"Panendoscopy of the upper aerodigestive tract","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-18-qi-4","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"You are moving towards the diagnosis of laryngeal cancer. Which of the following functional signs is related to a significant spread of cancer (one or more expected responses)?","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Otalgia right reflex","justification":""},{"idx":1,"correct":true,"proposition":"Dysphagia to solids","justification":""},{"idx":2,"correct":true,"proposition":"Laryngeal dyspnea","justification":""},{"idx":3,"correct":true,"proposition":"Bloody Spit","justification":""},{"idx":4,"correct":true,"proposition":"Swallowing disorders with false routes mainly when ingesting fluids","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-18-qi-5","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"During the clinical examination of the patient, what are the essential gestures to be performed (one or more expected answers)? ","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Dental examination","justification":""},{"idx":1,"correct":true,"proposition":"Complete inspection of the oropharynx and oral cavity","justification":""},{"idx":2,"correct":true,"proposition":"Endooral palpation","justification":""},{"idx":3,"correct":false,"proposition":"Otoscopy","justification":""},{"idx":4,"correct":true,"proposition":"Precise examination of lymph node areas","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-18-qi-6","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"You highlight cervical lymphadenopathy. What are the elements to be specified during the clinical examination (one or more expected answers)?","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Seat"},{"idx":1,"correct":true,"proposition":"Waist"},{"idx":2,"correct":true,"proposition":"Deep infiltration"},{"idx":3,"correct":true,"proposition":"Skin condition in relation to"},{"idx":4,"correct":false,"proposition":"Compression of the internal jugular vein","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-18-qi-7","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"At the end of your clinical examination, you perform a pharyngolaryngeal nasofibroscopy. You highlight a tumor of the right hemilarynx with the presence of several right cervical lymphadenopathy. What are the important elements missing from the description of your clinical examination (one or more expected answers)? ","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Tumour colour","justification":""},{"idx":1,"correct":true,"proposition":"Macroscopic appearance of the tumour","justification":""},{"idx":2,"correct":true,"proposition":"Mobility of the right arytenoid","justification":""},{"idx":3,"correct":true,"proposition":"Mobility of the right vocal fold","justification":""},{"idx":4,"correct":true,"proposition":"Tumour size","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-18-qi-8","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"For this patient, what are the examinations you request as part of the locoregional and general extension assessment (one or more expected answers)? ","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"PET scanner","justification":""},{"idx":1,"correct":false,"proposition":"Ultrasound of the vessels of the neck","justification":""},{"idx":2,"correct":false,"proposition":"Cervical MRI","justification":""},{"idx":3,"correct":true,"proposition":"Cervico-thoracic CT with injection","justification":""},{"idx":4,"correct":true,"proposition":"Panendoscopy of the upper aerodigestive tract under general anesthesia","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-18-qi-9","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"You decide to perform a panendoscopy of the upper aerodigestive tract under general anesthesia. An anesthesia consultation is mandatory. What are the characteristics of this consultation (one or more expected answers)? ","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"It is governed by a decree of the Public Health Code","justification":""},{"idx":1,"correct":false,"proposition":"It is performed by the anaesthetist who will practice anesthesia during surgery","justification":""},{"idx":2,"correct":true,"proposition":"Informing the patient about the anesthesia procedure is mandatory","justification":""},{"idx":3,"correct":false,"proposition":"It is performed by any doctor regardless of his specialty","justification":""},{"idx":4,"correct":true,"proposition":"It is performed at least 48 hours before panendoscopy","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-18-qi-10","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"Which of the following biological examinations is essential before performing panendoscopy? ","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Calcium phosphate balance","justification":""},{"idx":1,"correct":false,"proposition":"Carcinoembryonic antigen (CEA) test","justification":""},{"idx":2,"correct":false,"proposition":"Determination of transaminases","justification":""},{"idx":3,"correct":false,"proposition":"CRP testing","justification":""},{"idx":4,"correct":true,"proposition":"Haemostasis assessment including INR, TCA, p lacquettes","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-18-qi-11","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"The cervico-thoracic CT scan was performed. What are the exact proposals (one or more expected answers)? ","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"1 refers to cricoid cartilage","justification":""},{"idx":1,"correct":true,"proposition":"1 refers to thyroid cartilage","justification":""},{"idx":2,"correct":false,"proposition":"2 refers to epiglottic cartilage","justification":""},{"idx":3,"correct":true,"proposition":"2 refers to the laryngeal tumour","justification":""},{"idx":4,"correct":true,"proposition":"3 refers to the sternocleidostoid muscle","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-18-qi-12","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"At the end of all the examinations performed, the final diagnosis is a moderately differentiated squamous cell carcinoma of the right hemianx classified T3N2bM0. What are the mandatory rules to respect for the management of a patient with carcinoma (one or more expected responses)? ","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Decision on taking charge in a multidisciplinary consultation meeting (RCP)","justification":""},{"idx":1,"correct":true,"proposition":"Management defined in agreement with the patient","justification":""},{"idx":2,"correct":true,"proposition":"Care at an authorized facility","justification":""},{"idx":3,"correct":true,"proposition":"Mandatory notification consultation","justification":""},{"idx":4,"correct":true,"proposition":"Application for inclusion on the list of long-term conditions made by the attending physician","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-18-qi-13","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"During the multidisciplinary consultation meeting, it was decided to propose a laryngeal preservation strategy with two chemotherapy courses combining cisplatin, 5FU, Docetaxel. Which of the following complications could be related to cisplatin (one or more expected responses)?","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Renal failure","justification":""},{"idx":1,"correct":true,"proposition":"Hearing loss","justification":""},{"idx":2,"correct":false,"proposition":"Mucite","justification":"The college of oncology does not report it! We were as surprised as you probably are now 😖."},{"idx":3,"correct":true,"proposition":"Dysesthesia of the extremities","justification":""},{"idx":4,"correct":true,"proposition":"Nausea, vomiting","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-18-qi-14","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"Because of the 5FU treatment, what toxicity do you monitor first? (Only one answer expected)","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Neurological toxicity","justification":""},{"idx":1,"correct":false,"proposition":"Liver toxicity","justification":""},{"idx":2,"correct":true,"proposition":"Cardiac toxicity","justification":"Beware of coronary spasms"},{"idx":3,"correct":false,"proposition":"Digestive toxicity","justification":""},{"idx":4,"correct":false,"proposition":"Renal toxicity","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2019-dp-18-qi-15","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"After two courses of chemotherapy, a regression of tumor volume greater than 50% associated with remobilization of the right hemilarynx was highlighted. was decided to perform cetuximab-sensitized radiotherapy. What are the complications of radiotherapy that could be observed in the medium or long term (one or more expected responses)?","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Hyposialia","justification":""},{"idx":1,"correct":true,"proposition":"Hypothyroidism","justification":""},{"idx":2,"correct":true,"proposition":"Laryngeal edema","justification":""},{"idx":3,"correct":true,"proposition":"Laryngeal dyspnea","justification":""},{"idx":4,"correct":true,"proposition":"Cervical sclerosis","justification":""}],"ts":{"$numberLong":"1665228769750"},"type":"dp"}
-{"_id":"annales-2020-dp-1-qi-1","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"What is your main diagnostic hypothesis? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Obliterating arterial disease of the lower limbs","justification":"This is the typical presentation"},{"idx":1,"correct":false,"proposition":"Narrow lumbar canal","justification":""},{"idx":2,"correct":false,"proposition":"Lombosciatica","justification":""},{"idx":3,"correct":false,"proposition":"Hypokalemia","justification":""},{"idx":4,"correct":false,"proposition":"Deep vein thrombosis","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-1-qi-2","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"You suspect arterial disease obliterating the lower limbs. Which of the following semiological elements will guide the diagnosis towards this hypothesis? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Occurrence of pain when walking","justification":""},{"idx":1,"correct":true,"proposition":"Symptomatology type of calf cramp","justification":""},{"idx":2,"correct":false,"proposition":"Reduction of pain by leaning forward","justification":"This is the description of the famous shopping cart sign, found in the narrowed lumbar canal"},{"idx":3,"correct":false,"proposition":"Disappearance of pain gradually for several hours","justification":"Decrease in pain at cessation of exertion in PAD. It is the onset of pain that is progressive."},{"idx":4,"correct":true,"proposition":"Faster onset of symptoms when the patient climbs a slope","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-1-qi-3","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"The interrogation confirms the appearance of a pain when walking with a cramp type localized in the right calf. The pain manifests itself early when the patient climbs a slope, thus supporting your diagnostic hypothesis of arterial obliterating disease of the lower limbs. On clinical examination, the patient measures 1.77 m, weighs 70 kg and the blood pressure is 134\/68 mmHg in both arms. Abdominal palpation does not perceive pulsatile or expansive mass. At the level of the lower left limb all peripheral pulses are found, the popliteal pulse seems however too well perceived. At the level of the lower right limb, only the femoral pulse is found. At auscultation you will find only a right cervical murmur and a murmur in the upper 1\/3 of the left thigh. On the data of this clinical examination, which is(are) the arterial atheromatous lesion(s) that you should suspect?","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Stenosis of the right external iliac artery","justification":""},{"idx":1,"correct":true,"proposition":"Left common femoral artery stenosis","justification":"The perception of a murmur on auscultation points to stenosis of the artery. Not to be confused with an obliteration, which corresponds to a total stenosis, that is to say that the blood does not pass at all. At the auscultation of an obliteration, we do not find a breath. On palpation of an obliteration, no pulse is found."},{"idx":2,"correct":true,"proposition":"Right common femoral artery stenosis","justification":"No pulse = total stenosis."},{"idx":3,"correct":true,"proposition":"Left popliteal artery aneurysm","justification":"Pulse too well perceived = aneurysm"},{"idx":4,"correct":false,"proposition":"Left leg artery stenosis","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-1-qi-4","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"You mention the existence of a stenosis of the left femoral artery, a left popliteal aneurysm and a right femoral obliteration-reinjection. To confirm the diagnosis of obliterating arterial disease of the lower limbs you perform a measurement of the Systolic Pressure Index (SPI) in the ankle. The SPI is 0.67 at the lower right limb and 0.85 at the left lower limb. What are the semiological value and limitations of this parameter? (one or more correct answers). ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"When the SNI is less than 0.90, it confirms the diagnosis of peripheral arterial disease","justification":"The SPI standard is between 0.9 and 1.3 (1.4 is found as the higher standard in some sources). Below 0.9, he signs an AOMI. Above 1.3 (or 1.4), it signs arterial incompressibility (found in diabetic patients and chronic renal failure dialysis) due to mediacalcosis (calcification of the media, the intermediate tunica of the vessels, between the intima and the weed). An IPS below 0.7 indicates severe PAD."},{"idx":1,"correct":true,"proposition":"When the SNI is less than 0.90, it indicates an over-risk of cardiovascular morbidity and mortality","justification":""},{"idx":2,"correct":true,"proposition":"When the SPI is greater than 1.40, it indicates arterial stiffness associated with mediacalcosis","justification":""},{"idx":3,"correct":true,"proposition":"The presence of a mediacalcosis requires the use of toe pressure and not ankle pressure for the calculation of the IPS","justification":"This is the way we have found to counter the mediacalcolsis. The arteries of the toe are less prone to medicalcolsis. However, it should not be forgotten that it is physiological that the pressure of the toe is lower than the pressure of the ankle. The standard is therefore lower. Indeed, in case of taking the voltage of the ortel, the standard of the IPS is then 0.7"},{"idx":4,"correct":false,"proposition":"ABI should be measured in patients suspected of acute sensory-motor ischemia to confirm diagnosis","justification":"Acute limb ischemia is a medical-surgical, functional and even vital emergency. No examination should slow down management."}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-1-qi-5","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"To specify the arterial lesion assessment, which is (are) the additional first-line examination(s) you are requesting? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"arteriography of the aorta and lower limbs","justification":""},{"idx":1,"correct":true,"proposition":"Doppler ultrasound of the abdominal aorta and arteries of the lower limbs","justification":"Makes it possible to precisely identify lesions, to evaluate the degree of stenosis and to objectify functional adaptation."},{"idx":2,"correct":true,"proposition":"a Doppler ultrasound of arterial axes for cervico-encephalic purposes","justification":"In the previous questions, the patient has a cervical murmur. It must therefore be explored."},{"idx":3,"correct":false,"proposition":"angio-MRI of the arterial axes for cervico-encephalic","justification":""},{"idx":4,"correct":false,"proposition":"CT angiography of the aorta and lower limbs","justification":"Is done pre-operatively of a revascularization"}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-1-qi-6","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"You asked in first intention the realization of a Doppler ultrasound of the axes for cervico-encephalic use, the aorta and the lower limbs to specify the arterial lesions. This objective examination an atheromatous overload at the level of the arterial axes of the supra-aortic trunks without significant stenosis. The abdominal aorta is regular and measures 28 mm in anteroposterior diameter. There is an obliteration of the right femoral artery with reinjection of the popliteal artery. There is also stenosis in the middle third of the left femoral artery. The left popliteal artery is regular and measures 13 mm in diameter in its widest dimension. Given the absence of a threatening lesion, you decide to treat this patient medically. What therapeutic measure(s) are you going to put in place? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Statine","justification":"Drug treatment of intermittent claudication is based on anti-platelet aggregation (by aspirin at anti-aggregating dose), an inhibitor of the converting enzyme (ACE inhibitor, the patient is already on perindopril for his hypertension, so we will keep it), and a statin (with an LDLc goal of less than 0.7 g \/ L because we are in secondary prevention,  the lesions are already there). It is associated with therapeutic education (sports activity, smoking cessation, Mediterranean diet, ...) and rehabilitation to progressive effort. Finally, we can discuss a gesture of revascularization."},{"idx":1,"correct":false,"proposition":"Beta-blocker to replace perindopril","justification":"ACE inhibitor is the treatment of choice in PAD"},{"idx":2,"correct":true,"proposition":"Antiplatelet agent","justification":"Treatment formally indicated from the stage of intermittent claudication. It is discussed in case of completely asymptomatic PAD (rare case)."},{"idx":3,"correct":false,"proposition":"Direct oral anticoagulant","justification":"We are not dealing with a coagulation problem. Neither AOD nor Heparin are therefore indicated. Indeed, in the arterial circuit, it is mainly a problem of primary hemostasis (platelet aggregation and formation of a thrombus) that may arise."},{"idx":4,"correct":false,"proposition":"Low molecular weight heparin","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-1-qi-7","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"In addition to drug treatment, what advice(s) will you give to your patient? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Smoking cessation","justification":"The patient still smokes"},{"idx":1,"correct":false,"proposition":"Low-calorie diet","justification":"He is not overweight"},{"idx":2,"correct":false,"proposition":"Strict salt-free diet","justification":"His high blood pressure seems to be under control. Even if this were not the case, we would potentially advise a low-sodium (<6g\/D) and unsodized (<4g\/D) diet. The latter, the soda diet, is reserved for cases of cirrhosis with refractory ascites for example."},{"idx":3,"correct":false,"proposition":"Hypoglycemic diet","justification":"He is not diabetic"},{"idx":4,"correct":true,"proposition":"30-minute walk a day 5 times a week","justification":"That's 150 minutes of physical activity per week"}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-1-qi-8","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"You see the patient again after 6 months of treatment and prescribe a treadmill walking test. Regarding this review, what is the exact proposal(s)? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"It makes it possible to assess the disability related to arterial disease obliterans of the lower limbs ","justification":"The shorter the patient can walk, the greater the disability."},{"idx":1,"correct":false,"proposition":"It makes it possible to measure in a standardized way the distance traveled in 6 minutes","justification":"This proposal refers to the 6-minute walking test (TM6), useful in pulmonology. It consists of measuring the distance that a patient can travel in 6 minutes. Here, the test of walking on a treadmill is something else entirely: the patient puts himself on a treadmill advancing at 3.2km\/h with a slope of 10%, and he walks as long as possible (no time limit)."},{"idx":2,"correct":true,"proposition":"It allows a reassessment of SNPs after walking","justification":"The SPI is evaluated after walking and compared to that at rest."},{"idx":3,"correct":false,"proposition":"It is only intended for patients with mediacalcosis","justification":"There is no real connection with medicalcosis 😅"},{"idx":4,"correct":true,"proposition":"It allows the evaluation of the functional value of collateral circulation","justification":"The longer the patient can walk, the more the collateral circulation ensures a satisfactory locum function."}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-1-qi-9","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"The walking test shows only moderate functional disability, compatible with continued medical treatment. The cardiologist consulted beforehand performed a stress ultrasound on dobutamine which does not show signs of myocardial ischemia. Resting echocardiography is also normal, with the exception of the presence of dilatation of the left atrium. Smoking cessation is ongoing. The patient is treated with atorvastatin, aspirin and perindopril. A year later, he consulted the cardiologist for palpitations that had been evolving episodically for several weeks. What is the possible cause(s) of palpitations in this patient? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Atrial tachycardia","justification":"Atrial tachycardia can cause palpitations (this is what you can feel after a 100m sprint at the end of D4 🤭 #vecu)."},{"idx":1,"correct":true,"proposition":"Atrial extrasystoles","justification":"If there are many and as a result, it is possible to feel palpitations. This is also the case for ventricular extrasystoles."},{"idx":2,"correct":false,"proposition":"Paroxysmal atrioventricular block","justification":"We find rather a bradycardia. It is not a cause of palpitation."},{"idx":3,"correct":true,"proposition":"Atrial fibrillation","justification":"First etiology to look for in case of palpitations."},{"idx":4,"correct":false,"proposition":"Ventricular fibrillation","justification":"Ventricular fibrillation never returns to normal on its own, and leads to cardiorespiratory arrest quickly and death if left untreated. If the patient had had VF, we would know."}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-1-qi-10","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"An electrocardiogram is performed, of which here is the trace.","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"junctional tachycardia"},{"idx":1,"correct":true,"proposition":"atrial fibrillation"},{"idx":2,"correct":false,"proposition":"Atrial Flutter"},{"idx":3,"correct":false,"proposition":"atrial extrasystoles"},{"idx":4,"correct":false,"proposition":"sinus tachycardia"}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-1-qi-11","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"Which factor(s) were considered to assess the thromboembolic risk of atrial fibrillation in this patient? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Peripheral arterial disease (PAD)","justification":""},{"idx":1,"correct":false,"proposition":"Smoking","justification":""},{"idx":2,"correct":true,"proposition":"History of high blood pressure (hypertension)","justification":""},{"idx":3,"correct":true,"proposition":"Age","justification":""},{"idx":4,"correct":false,"proposition":"The recent nature of atrial fibrillation (AF)","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-1-qi-12","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"Renal function is normal and treatment with direct oral anticoagulant with apixaban is started due to age over 65 years, high blood pressure and peripheral arterial disease. The very reliable interrogation of the patient makes it possible to specify that palpitations occur in episodes whose duration varies between 6 and 72 hours. How to qualify this atrial fibrillation according to the data collected (only one answer)?","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Persistent","justification":""},{"idx":1,"correct":false,"proposition":"Perm","justification":""},{"idx":2,"correct":false,"proposition":"Isolated","justification":""},{"idx":3,"correct":true,"proposition":"Paroxysmal","justification":"Spontaneous reduction in less than 7 days (here 'between 6 and 72 hours' according to the statement)."},{"idx":4,"correct":false,"proposition":"Resistant","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-1-qi-13","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"This is paroxysmal atrial fibrillation. You decide to prescribe a beta-blocker to slow the frequency of atrial fibrillation. After 3 days of treatment, the patient presents to the emergency room for lipothymia and exertional dyspnea. The electrocardiogram shows only sinus bradycardia at 42 beats \/ minute. Blood pressure is normal, the patient is asymptomatic to decubitus, there is no sign of low flow, diuresis is preserved, pulmonary auscultation is normal. What is your care? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Modification of treatment and return home","justification":""},{"idx":1,"correct":true,"proposition":"Suspension of beta-blocker and resumed at reduced doses","justification":"It is probably the introduction of the beta-blocker that is at the origin of bradycardia, therefore of the patient's symptomatology. We therefore stop the offending drug, with a wash-out period, then resume in small doses when the patient stabilizes, finding a dose that optimizes the benefit\/risk balance."},{"idx":2,"correct":false,"proposition":"Placement of a percutaneous electrosystolic training probe","justification":""},{"idx":3,"correct":false,"proposition":"Isoprenaline infusion","justification":""},{"idx":4,"correct":false,"proposition":"Installation of a permanent pacemaker","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-1-qi-14","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"This is an adverse reaction of the beta-blocker whose dosage was not adequate. After dose reduction, the situation stabilizes favorably. Treatment with direct oral anticoagulant is continued. A few weeks later, the patient presents again for an attack of atrial fibrillation prolonged for more than 4 days but perfectly well tolerated under beta-blocker. You offer him an electrical cardioversion scheduled for the coming weeks. What will be the condition(s) for achieving this electrical cardioversion? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Previous transesophageal echocardiography","justification":"ETO is not useful if cardioversion is covered by 3 weeks of anticoagulation before."},{"idx":1,"correct":false,"proposition":"Relay of direct oral anticoagulant by low molecular weight heparin at curative dose","justification":"We are very happy with the AOD 😊. Furthermore, LMWHs do not have MA in atrial fibrillation. So, at the ECN, you should never tick them! The HnF will then be used."},{"idx":2,"correct":false,"proposition":"Realization at low energy under light sedation by midazolam","justification":"Must be done under general anesthesia (an external electric shock, it hurts a lot!). 😰"},{"idx":3,"correct":true,"proposition":"Anesthesia consultation","justification":"The medico-legal delay of an anesthesia consultation is at least 48 hours. The pre-anesthetic visit is carried out a few hours before."},{"idx":4,"correct":false,"proposition":"Weekly INR check for a target between 2 and 3","justification":"DOACs do not have biological monitoring parameters, which is sometimes problematic (when one needs to measure its effect exactly, for example when introducing a drug known for its enzymatic inducing effect)."}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-1-qi-15","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"Electrical cardioversion is successfully performed two weeks later. Antiarrhythmic treatment is undertaken by flecainide which makes the symptoms disappear. The patient asks you about stopping direct oral anticoagulant therapy now that the atrial fibrillation has disappeared. What do you say to him (one correct answer)? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Discontinuation of direct oral anticoagulant therapy 4 weeks after cardioversion","justification":"This proposition would have been true if he had a CHADS-VASc at 0, or if he was under 65 and a purely isolated AF."},{"idx":1,"correct":false,"proposition":"Discontinuation of direct oral anticoagulant therapy if long-term Holter recording is normal","justification":""},{"idx":2,"correct":true,"proposition":"Indefinite maintenance of direct oral anticoagulant therapy","justification":"Its CHADS-VASc at 3 requires long-term anticoagulation."},{"idx":3,"correct":false,"proposition":"Discontinuation of direct oral anticoagulant therapy after 12 months without documented relapse of atrial fibrillation","justification":""},{"idx":4,"correct":false,"proposition":"Discontinuation of direct oral anticoagulant therapy if echocardiography shows haemodynamic efficacy of atrial systole","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-1-qi-16","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"You continued the anticoagulant treatment. The patient asks you about the reasons for the occurrence of atrial fibrillation in his case. What do you say (one or more exact answers)? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"It is an arrhythmia frequently associated with arterial disease obliterans of the lower limbs","justification":"No report 😅🤭"},{"idx":1,"correct":false,"proposition":"It is a consequence of his smoking","justification":"Questionable proposal. Smoking is indeed a predisposing factor to heart disease, but establishing a direct link between FA tobacco 👉 seems too bold."},{"idx":2,"correct":true,"proposition":"It is a common arrhythmia in case of high blood pressure","justification":"High blood pressure is the leading cause of atrial fibrillation."},{"idx":3,"correct":false,"proposition":"It is an arrhythmia favored by its sedentary lifestyle","justification":"No report, especially in this patient who is neither diabetic nor overweight."},{"idx":4,"correct":true,"proposition":"It is an arrhythmia frequently associated with sleep apnea syndrome.","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-2-qi-1","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"What pathology(s) does the gynecological clinical examination (inspection, speculum examination and vaginal examination) allow you to eliminate with certainty? ","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"An endometrial polyp","justification":""},{"idx":1,"correct":false,"proposition":"A uterine fibroid","justification":""},{"idx":2,"correct":true,"proposition":"Vaginal cancer","justification":""},{"idx":3,"correct":false,"proposition":"Cervical dysplasia","justification":"The diagnosis of cervical dyaplsia is pathological pathology."},{"idx":4,"correct":false,"proposition":"Malignant tumor of the ovary","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-2-qi-2","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"On examination, the vaginal wall is unremarkable and the cervix is normal. Which additional exam(s) do you prescribe as a first-line treatment?","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"An x-ray of the abdomen without preparation","justification":"Hardly ticks anymore..."},{"idx":1,"correct":true,"proposition":"An abdominopelvic ultrasound","justification":"The king first-line examination in gynecology 👑"},{"idx":2,"correct":false,"proposition":"An abdomino-pelvic CT scan","justification":""},{"idx":3,"correct":false,"proposition":"Abdominopelvic magnetic resonance imaging","justification":""},{"idx":4,"correct":false,"proposition":"Hysterosalpingography","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-2-qi-3","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"A pelvic ultrasound is performed. It reveals a cystic right ovarian mass of about 6 cm with vascularized vegetation, a left hydrosalpinx and a left ovary carrying cystic formation with pure fluid content. The endometrial thickness is 18 mm with hypervascularization. There is also minimal peritoneal fluid effusion. What argument(s) is (or are) in favor of a malignant pathology? ","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Peritoneal effusion","justification":"It is minimal 👉 osef"},{"idx":1,"correct":false,"proposition":"The size of the right adnexal lesion","justification":"The size less than 7cm is a reassuring element."},{"idx":2,"correct":false,"proposition":"Left tubal lesion","justification":""},{"idx":3,"correct":false,"proposition":"Left ovarian lesion","justification":"Cystic nature is reassuring"},{"idx":4,"correct":true,"proposition":"The existence of vascularized vegetation on the right annex","justification":"The intense vascularization of a lesion is often in favor of malignancy (by secretion of VEGF from tumor cells)."}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-2-qi-4","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"In this context, the right ovarian lesion as well as the endometrial thickness worry you. What other imaging exam(s) will you perform? ","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Abdominopelvic magnetic resonance imaging with Gadolinium injection","justification":""},{"idx":1,"correct":false,"proposition":"A brain scan","justification":""},{"idx":2,"correct":false,"proposition":"Fluoro-Deoxy-Glucose positron emission tomography","justification":""},{"idx":3,"correct":false,"proposition":"A bone scan","justification":""},{"idx":4,"correct":false,"proposition":"A liver ultrasound","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-2-qi-5","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"Along with the MRI you request. What biological marker(s) will you dose for this patient? ","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Ca 125","justification":"Ovarian cancer marker"},{"idx":1,"correct":false,"proposition":"Alfa-fetoprotein","justification":""},{"idx":2,"correct":false,"proposition":"Beta-HCG","justification":"Look at the patient's 😉 age (and don't blame yourself for checking it, but make sure you NEVER get caught up in this trap 🤗)"},{"idx":3,"correct":false,"proposition":"Ca 19.9","justification":"Marker of ovarian cancer. ACE and HE4 would be added. Note that the use of these markers is discussed."},{"idx":4,"correct":false,"proposition":"SCC","justification":"Marker of squamous cell cancers"}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-2-qi-6","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"The results of the markers: \n\nCA 15.3: 25U\/mL \n\nCA 125: 40 Ul\/ml. \n\nA pelvic MRI is performed. The radiologist confirms the strong suspicion of malignant lesion of the right ovary and endometrium, as well as the a priori benign nature of the lesions of the left appendix. What do you do to support the diagnosis? (one or more possible answer(s)) ","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Puncture of the peritoneal effusion vaginally","justification":""},{"idx":1,"correct":false,"proposition":"Right ultrasound-guided ovarian biopsy vaginally","justification":""},{"idx":2,"correct":true,"proposition":"Diagnostic hysteroscopy","justification":"For the endometrium"},{"idx":3,"correct":true,"proposition":"Laparoscopy explorer","justification":"For the ovary"},{"idx":4,"correct":false,"proposition":"Right ovarian biopsy under CT scan","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-2-qi-7","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"Laparoscopy is performed. What do you expect? (one or more possible answer(s)) ","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Surgical removal of the right ovary","justification":""},{"idx":1,"correct":false,"proposition":"Staging swab","justification":""},{"idx":2,"correct":false,"proposition":"Surgical endometrial sampling","justification":"The endometrium is not removed directly."},{"idx":3,"correct":true,"proposition":"Assessment of the resectability of lesions","justification":""},{"idx":4,"correct":true,"proposition":"Assessment of peritoneal extension of the disease","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-2-qi-8","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"Laparoscopy did not show peritoneal extension. The histological results of the endometrial sample are: grade II invasive endometrioid adenocarcinoma. The histological results of the right adnexal swab: an intraovarian endometrioid adenocarcinoma lesion without extension to the surface or tubal wall. What treatment should be performed? ","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"A total hysterectomy with bilateral appendectomy","justification":""},{"idx":1,"correct":false,"proposition":"Expanded colpohysterectomy with bilateral appendectomy","justification":"The cervix is healthy. There is no indication to remove it."},{"idx":2,"correct":false,"proposition":"Abdominopelvic external beam radiation therapy combined with concomitant chemotherapy","justification":""},{"idx":3,"correct":false,"proposition":"Neoadjuvant chemotherapy","justification":""},{"idx":4,"correct":false,"proposition":"Tamoxifen-based hormone therapy","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-2-qi-9","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"Regarding the epidemiological data of the type of endometrial cancer (endometrioid) of this patient, what is(are) the exact statement(s)?","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"It is the most common gynecological (pelvic) cancer","justification":""},{"idx":1,"correct":true,"proposition":"It is a cancer of epithelial origin","justification":""},{"idx":2,"correct":true,"proposition":"It is a hormone-dependent cancer","justification":""},{"idx":3,"correct":false,"proposition":"It is a cancer of poor prognosis","justification":""},{"idx":4,"correct":true,"proposition":"Tamoxifen is a risk factor","justification":"Because hormone-dependent cancer"}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-2-qi-10","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"The patient's file is presented at a multidisciplinary consultation meeting (RCP). Regarding CPR, what is(es) the correct answer(s)? ","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"It is not mandatory pre-operative","justification":"Except in very special cases (emergency for example), CPR is mandatory"},{"idx":1,"correct":false,"proposition":"It is the referring surgeon who proposes a therapeutic strategy","justification":""},{"idx":2,"correct":true,"proposition":"Doctors from three different specialties must be present","justification":""},{"idx":3,"correct":false,"proposition":"The support person can attend CPR","justification":"It's a meeting between doctors"},{"idx":4,"correct":true,"proposition":"Decisions must be based on a repository","justification":"The decision is based on the objective data of science"}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-2-qi-11","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"The patient's attending physician applies for admission to a long-term condition (ALDI. Which of the following is correct? ","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The care protocol must be drawn up by the attending physician, in consultation with the patient and the other corresponding physician(s) involved in the follow-up.","justification":""},{"idx":1,"correct":false,"proposition":"ALD recognition allows 100% coverage of all health costs","justification":""},{"idx":2,"correct":false,"proposition":"The patient will be able to enjoy the benefits of her ALD for life","justification":""},{"idx":3,"correct":true,"proposition":"ALD recognition commits the patient to respond to the controls carried out by her health insurance organization","justification":""},{"idx":4,"correct":false,"proposition":"Part of the fee overruns billed by health professionals may be covered by the ALD.","justification":"Fee overruns are not covered by ALD."}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-2-qi-12","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"Given the carcinological history of the patient and her family, what is (or are) the exact proposal(s)?","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"A family predisposition is strongly suspected","justification":""},{"idx":1,"correct":false,"proposition":"A pelvic ultrasound is indicated in her daughter","justification":""},{"idx":2,"correct":false,"proposition":"A CA15.3 assay is indicated in his daughter","justification":""},{"idx":3,"correct":true,"proposition":"An onco-genetic consultation should be recommended","justification":""},{"idx":4,"correct":true,"proposition":"A search for microsatellite instability is done on operating room","justification":"Lynch syndrome is suspected. We therefore look for the corresponding mutations on the operating room."}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-2-qi-13","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"Which familial form do you suspect first?","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Un syndrome de Lynch"},{"idx":1,"correct":false,"proposition":"A BRCA1 mutation"},{"idx":2,"correct":false,"proposition":"A BRCA2 mutation"},{"idx":3,"correct":false,"proposition":"A mutation in the PTEN gene"},{"idx":4,"correct":false,"proposition":"Un syndrome de Li-Fraumeni"}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-2-qi-14","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"At the end of her treatment, the patient is considered in complete remission. What monitoring do you put in place for the first two years? (one or more possible answers) ","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"A biannual clinical examination","justification":""},{"idx":1,"correct":false,"proposition":"A semi-annual assay of the serum marker CA 15.3","justification":"This is the CA 125 test for ovarian 🤭 cancer"},{"idx":2,"correct":false,"proposition":"An annual pelvic thoracoabdomino CT scan","justification":"No indication for systematic imaging"},{"idx":3,"correct":false,"proposition":"A biannual abdominal-pelvic ultrasound","justification":"No indication for systematic imaging"},{"idx":4,"correct":false,"proposition":"An annual mammogram","justification":"She had breast cancer 👉 Annual mammogram for life."}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-3-qi-1","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"In front of this sleep disorder, you must look for Theo:","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"An adjustment disorder","justification":"It cannot be eliminated in the face of compatible symptoms and lack of information on the duration of the disorders. There are many possible triggering factors (domestic violence, moving, entry into a small section)."},{"idx":1,"correct":false,"proposition":"Early schizophrenia","justification":""},{"idx":2,"correct":true,"proposition":"Obstructive sleep apnea syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Oppositional disorder with provocation","justification":"Sleep disorders are against this diagnosis. Irritability and anger do not seem to be taken to extremes and can be explained by lack of sleep."},{"idx":4,"correct":true,"proposition":"Reactive attachment disorder","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-3-qi-2","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"Among the symptoms presented by Theo, which is an obstructive sleep apnea syndrome? ","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Irritability","justification":""},{"idx":1,"correct":true,"proposition":"Snoring","justification":""},{"idx":2,"correct":true,"proposition":"Daytime sleepiness","justification":""},{"idx":3,"correct":false,"proposition":"Difficulty falling asleep","justification":""},{"idx":4,"correct":false,"proposition":"Refusal to sleep alone","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-3-qi-3","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"In the context of this sleep disorder, what do you recommend at first?","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Sleep hygiene tips","justification":""},{"idx":1,"correct":true,"proposition":"Behavioural measures","justification":""},{"idx":2,"correct":false,"proposition":"A prescription for melatonin","justification":""},{"idx":3,"correct":false,"proposition":"A prescription of anti-histamine for hypnotic purposes","justification":""},{"idx":4,"correct":false,"proposition":"A sleep cure","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-3-qi-4","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"You gave Theo's mother advice about sleep hygiene and how to behave with him. Six months later, you see the child again in consultation because the drowsiness is more and more marked. His school entry went well but, at times, he falls asleep in class. These phases are interspersed with phases of significant irritability associated with relational difficulties with other students. This boy is now 3 years and 6 months old, 1 meter tall and weighs 22 kilograms. The rest of the somatic clinical examination is normal. Faced with this drowsiness, among the following proposals, which is the most relevant in the first line? ","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A psychological assessment","justification":""},{"idx":1,"correct":false,"proposition":"Ventilatory polygraphy","justification":""},{"idx":2,"correct":false,"proposition":"A brain MRI","justification":""},{"idx":3,"correct":true,"proposition":"An ENT consultation","justification":""},{"idx":4,"correct":false,"proposition":"An electrocardiogram","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-3-qi-5","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"The ENT consultation diagnoses obstructive sleep apnea syndrome and finds tonsillar hypertrophy and vegetations. Theo is operated on and the drowsiness disappears. Two years later, you see Theo again in consultation at the request of the teacher who describes a very difficult behavior: he never sits, does not wait his turn in class activities, does not respect the instructions and is very slow in his school work. The mother reports that he very often loses his belongings. Theo now sleeps in his own bed but demands a night light. Besides, he wets the bed. During your consultation, he does not hold in place and cuts you off. You suspect attention deficit hyperactivity disorder (ADHD). Your diagnostic hypothesis for ADHD is based on:","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Impulsivity"},{"idx":1,"correct":true,"proposition":"Motor instability"},{"idx":2,"correct":true,"proposition":"Nocturnal enuresis","justification":"About 10% of children with isolated primary nocturnal enuresis have attention deficit hyperactivity disorder (ADHD)."},{"idx":3,"correct":true,"proposition":"Slow execution","justification":"Inattention syndrome"},{"idx":4,"correct":false,"proposition":"Fear of the dark"}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-3-qi-6","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"Apart from being overweight, the rest of your physical exam is normal. To support your diagnosis of ADHD, you propose: ","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"An ophthalmological consultation","justification":""},{"idx":1,"correct":true,"proposition":"A questionnaire to be completed by the mother","justification":""},{"idx":2,"correct":true,"proposition":"A questionnaire to be completed by the teacher","justification":""},{"idx":3,"correct":false,"proposition":"A genetic assessment","justification":""},{"idx":4,"correct":false,"proposition":"A brain MRI","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-3-qi-7","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"The diagnosis of ADHD is confirmed. There is no associated learning disability. At this stage, you recommend: ","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":" Psychotherapy","justification":""},{"idx":1,"correct":false,"proposition":"Treatment with methylphenidate","justification":"This treatment is only possible from the age of 6. Theo is only 5 years old at this question. In addition, it is proposed as a second intention."},{"idx":2,"correct":true,"proposition":"Cognitive remediation","justification":""},{"idx":3,"correct":false,"proposition":"Speech therapy","justification":""},{"idx":4,"correct":false,"proposition":"Open educational assistance (AEMO)","justification":"AEMO is decided by a juvenile judge in special cases such as abuse."}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-3-qi-8","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"Six months later, Theo is 6 years old and faced with the little evolution of his disorders, you decide to prescribe methylphenidate. This molecule: ","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Is a derivative of amphetamines","justification":""},{"idx":1,"correct":true,"proposition":"Is contraindicated before 6 years","justification":""},{"idx":2,"correct":false,"proposition":"Can be prescribed for up to 3 months","justification":"28 days, no limit on the total duration of treatment."},{"idx":3,"correct":true,"proposition":"Can be renewed by the general practitioner","justification":"Today, this proposition is true. Since 2021, the prescription and renewal of methylphenidate can be initiated by any neurologist, psychiatry or pediatrician and renewed by any doctor."},{"idx":4,"correct":false,"proposition":"Is prescribed without taking into account school holidays","justification":"We reduce during school holidays"}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-3-qi-9","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"A few weeks after the introduction of the treatment, you see Theo and his mother again in consultation. Which of the following symptoms reported by his mother can methylphenidate be attributed to? ","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Increased appetite","justification":"Rather anorexia at lunch"},{"idx":1,"correct":true,"proposition":"Abdominal pain","justification":""},{"idx":2,"correct":true,"proposition":"Headaches","justification":""},{"idx":3,"correct":false,"proposition":"A sad mood","justification":""},{"idx":4,"correct":true,"proposition":"Difficulty falling asleep","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-3-qi-10","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"Three years later, Theo is admitted to the pediatric emergency room for a major attack of agitation at home. In a fit of anger, he broke his tablet and threatened to jump out of the window. He has just learned from his mother that his father, whom he did not know, committed suicide. You learn on this occasion that his mother lives with a new spouse and that intra-family relations are very tense, especially between Theo and his stepfather. Theo is now 9 years old and is enrolled in CE2. When you meet him, alone, he is calm and tells you about his discomfort. Overweight is manifest and badly experienced. Between sobs, he says: <<I'm tired of it, it's been going on too long. I can't take it anymore. >> In pediatric emergencies, management includes: ","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A prescription of an anti-histamine for anxiolytic purposes","justification":"It is described as calm at present."},{"idx":1,"correct":false,"proposition":"A prescription of a benzodiazepine for anxiolytic purposes","justification":""},{"idx":2,"correct":true,"proposition":"A referral to hospitalization","justification":""},{"idx":3,"correct":false,"proposition":"A report","justification":""},{"idx":4,"correct":false,"proposition":"A summons from the father-in-law","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-3-qi-11","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"Which of the following proposals is one or more of Theo's emergency hospitalization objectives? ","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Prevention of suicidal risk","justification":""},{"idx":1,"correct":true,"proposition":"Prolonged clinical observation","justification":""},{"idx":2,"correct":false,"proposition":"Reassessment of ADHD treatment","justification":"This is not an indication for emergency hospitalization"},{"idx":3,"correct":true,"proposition":"Distancing intra-family tensions","justification":""},{"idx":4,"correct":false,"proposition":"Multidisciplinary assessment","justification":"This is not an indication for emergency hospitalization"}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-3-qi-12","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"Theo is hospitalized in pediatrics. During an interview, he described sexual touching by his stepfather but refused to be told about it to his mother. Faced with this situation ","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"You avoid informing the mother","justification":""},{"idx":1,"correct":true,"proposition":"You make a report even if the mother objects","justification":""},{"idx":2,"correct":true,"proposition":"You make a report even without Theo's agreement","justification":""},{"idx":3,"correct":false,"proposition":"You identify the father-in-law on your certificate as responsible for the facts","justification":""},{"idx":4,"correct":false,"proposition":"You avoid transcribing Theo's words word for word","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-3-qi-13","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"To whom do you address your report?","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"To the Child Social Assistance (ASE)","justification":""},{"idx":1,"correct":false,"proposition":"To the social worker of the paediatric department","justification":""},{"idx":2,"correct":false,"proposition":"To the regional health agency (ARS)","justification":""},{"idx":3,"correct":true,"proposition":"To the public prosecutor","justification":""},{"idx":4,"correct":false,"proposition":"Maternal and Child Protection (PMI)","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-3-qi-14","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"The mother's spouse admits the facts and is incarcerated. A few weeks after his release from the hospital, Theo says he is reassured but remains sad and worried about his future. He is still treated with methylphenidate, which allows him to be calmer, but still has great academic difficulties. He has few classmates and often misses school due to somatic complaints. In view of this clinical picture, which diagnosis(s) should be mentioned?","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Depression","justification":""},{"idx":1,"correct":true,"proposition":"School phobia","justification":""},{"idx":2,"correct":false,"proposition":"Schizotypal personality disorder","justification":"A minor patient is not diagnosed with a personality disorder."},{"idx":3,"correct":false,"proposition":"Autism spectrum disorder","justification":""},{"idx":4,"correct":false,"proposition":"Conduct disorder","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-3-qi-15","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"Which of the following measures, due to his situation and his difficulties at school, which can be put in place for Theo? ","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"An individualized reception project (PAI)","justification":"The PAI makes it possible to arrange Theo's reception by informing his pedagogical managers of his pathology."},{"idx":1,"correct":true,"proposition":"Open educational assistance (AEMO)","justification":"Theo has been put in danger and his current social context is difficult. Mentioning an AEMO will allow the juvenile judge to assess the need for support for Theo."},{"idx":2,"correct":true,"proposition":"An allowance for the education of disabled children (AEEH)","justification":"The request is made to the MDPH."},{"idx":3,"correct":true,"proposition":"A personalized support project (PAP)","justification":"The PAP concerns learning disabilities, from which Theo seems to suffer."},{"idx":4,"correct":true,"proposition":"A school life assistant (AVS)","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-4-qi-1","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"What is the BMI (body mass index) in rounded value of this patient? ","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"25","justification":""},{"idx":1,"correct":true,"proposition":"30","justification":""},{"idx":2,"correct":false,"proposition":"35","justification":""},{"idx":3,"correct":false,"proposition":"40","justification":""},{"idx":4,"correct":false,"proposition":"45","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-4-qi-2","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"Which is (are) the most likely diagnostic hypothesis(s) in front of this clinical picture?","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Stasis dermohypodermatitis","justification":""},{"idx":1,"correct":true,"proposition":"Bacterial dermohypodermatitis","justification":""},{"idx":2,"correct":false,"proposition":"Necrotizing fasciitis","justification":""},{"idx":3,"correct":false,"proposition":"Lymphangitis","justification":""},{"idx":4,"correct":false,"proposition":"Erythema nodosum","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-4-qi-3","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"What clinical characteristic(s) is (are) in favor of non-necrotizing bacterial dermohypodermatitis? ","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Brutal start","justification":""},{"idx":1,"correct":false,"proposition":"Slow expansion","justification":"Expansion is fast"},{"idx":2,"correct":false,"proposition":"Centripetal evolution of skin lesions","justification":"Centrifugal evolution"},{"idx":3,"correct":false,"proposition":"Severe spontaneous pain","justification":"Palpation pain"},{"idx":4,"correct":true,"proposition":"Demonstration of intertoe intertrigo","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-4-qi-4","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"What comorbidity(ies) present in this patient is(are) a risk factor(s) for the occurrence of bacterial dermohypoderma? ","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Obesity","justification":""},{"idx":1,"correct":false,"proposition":"Diabetes","justification":"Risk factor for necrotizing dermohypodermitis."},{"idx":2,"correct":true,"proposition":"Venous insufficiency","justification":""},{"idx":3,"correct":false,"proposition":"History of phlebitis","justification":""},{"idx":4,"correct":false,"proposition":"High blood pressure","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-4-qi-5","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"You have several elements to orient you towards bacterial dermohypodermatitis especially as you find an intertrigo of the 2 feet. What gesture(s) do you perform in front of this lesion?","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Search for an increase in local skin temperature","justification":""},{"idx":1,"correct":true,"proposition":"Stripping of a small bullous detachment within the erythematous zone","justification":""},{"idx":2,"correct":false,"proposition":"Bacteriological swab of the most inflammatory area of erythema","justification":""},{"idx":3,"correct":true,"proposition":"Marking erythema contours with felt","justification":""},{"idx":4,"correct":true,"proposition":"Investigation of lymphadenopathy","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-4-qi-6","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"Palpation of the inguinal folds objective left inguinal lymphadenopathy. What is (are) the most likely cause(s) of this left inguinal lymphadenopathy?","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Concomitant inflammatory pathology of the small pelvis","justification":""},{"idx":1,"correct":false,"proposition":"Concomitant inflammatory pathology of the perineal region","justification":""},{"idx":2,"correct":false,"proposition":"Concomitant or perianal lesion","justification":""},{"idx":3,"correct":true,"proposition":"Satellite lymphadenopathy of dermohypodermatitis","justification":""},{"idx":4,"correct":false,"proposition":"Sentinel lymphadenopathy of lymphoma","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-4-qi-7","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"What is essential to achieve before starting the therapeutic management of this dermohypodermitis? (only one answer expected)","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Blood","justification":"Namely: blood cultures are positive in less than 5% of cases and are only to be performed in a particular context (bite, travel, occurring in an aquatic environment, post-traumatic, immunosuppression, nosocomial context, signs of clinical or biological seriousness)."},{"idx":1,"correct":false,"proposition":"Skin biopsy with culture","justification":""},{"idx":2,"correct":false,"proposition":"Doppler ultrasound of the leg","justification":""},{"idx":3,"correct":false,"proposition":"Left leg scanner"},{"idx":4,"correct":true,"proposition":"No additional assessment is essential","justification":"The form is typical and uncomplicated 👉 no additional examination. The diagnosis is clinical."}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-4-qi-8","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"Which infectious agent(s) is (are) most likely to be involved? ","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Streptococcus pyogenes","justification":""},{"idx":0,"correct":false,"proposition":"coagulase-negative staphylococcus","justification":"These are low-virulent staphylococci that are present on the skin commensally. These are often contaminants (S. Epidermidis ++)."},{"idx":0,"correct":false,"proposition":"Candida albicans","justification":""},{"idx":0,"correct":false,"proposition":"Pseudomonas ","justification":""},{"idx":0,"correct":false,"proposition":"Escherichia coli","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-4-qi-9","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"What is your first-line anti-infectious therapeutic option(s) (knowing that you decide to treat her at home because of the lack of signs of severity and that she has no known allergy)?","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Oral amoxicillin","justification":""},{"idx":0,"correct":false,"proposition":"Amoxicillin - Clavulanic Acid Orally"},{"idx":0,"correct":false,"proposition":"Pristinamycin orally (PO)","justification":"It is a treatment to be used in case of allergy to amoxicillin."},{"idx":0,"correct":false,"proposition":"Oral clindamycin","justification":"It is a treatment to be used in case of allergy to amoxicillin."},{"idx":0,"correct":false,"proposition":"3rd generation cephalosporin as intramuscular injection","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-4-qi-10","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"What associated treatment do you prescribe?","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Paracetamol","justification":""},{"idx":1,"correct":false,"proposition":"Nonsteroidal anti-inflammatory drugs","justification":""},{"idx":2,"correct":false,"proposition":"Calciparin curative dose","justification":""},{"idx":3,"correct":true,"proposition":"Rest with elevation of the left leg","justification":"This helps to evacuate the edema that accompanies the inflammatory phenomenon."},{"idx":4,"correct":true,"proposition":"Treatment of intertrigo","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-4-qi-11","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"You treat it with amoxicillin and paracetamol and plan to see it again 2 days later. Indeed, this patient is exposed to the risk of evolution to a necrotizing form. What is (are) the risk factor(s) of such a development? ","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Obesity","justification":"According to HAS, the risk factors for progression to a necrotizing form are: diabetes, nonsteroidal anti-inflammatory drugs, immunosuppression (corticosteroids, chemotherapy, immunosuppressants, chronic renal failure, cirrhosis), malnutrition, age over 60 years, intravenous drug addiction, venous insufficiency, peripheral arterial disease (PAD) and obesity. In children, chickenpox is the main risk factor for DHBN. The recommendation is here: https:\/\/www.has-sante.fr\/upload\/docs\/application\/pdf\/2019-04\/prise_en_charge_des_infections_cutanees_bacteriennes_courantes_recommandations.pdf"},{"idx":1,"correct":true,"proposition":"Diabetes","justification":""},{"idx":2,"correct":false,"proposition":"Smoking","justification":""},{"idx":3,"correct":true,"proposition":"Arterial disease of the lower limbs","justification":""},{"idx":4,"correct":true,"proposition":"Taking nonsteroidal anti-inflammatory drugs","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-4-qi-12","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"Under treatment, dermohypodermatitis disappears. You see the patient again 3 months later because her company sends her to do an accounting in Abidjan in Côte d'Ivoire for 3 weeks. She has never traveled to Africa. What vaccination(s) do you offer? ","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Update of its diphtheria-tetanus-polio vaccines","justification":""},{"idx":1,"correct":true,"proposition":"Hepatitis A vaccine","justification":""},{"idx":2,"correct":true,"proposition":"Meningitis vaccine ACYW135","justification":"This proposal is contentious. This vaccine is indicated in case of close and prolonged contact with the local population in an epidemic\/endemic area. Is this the case in the case of public accounting? It's hard to know 🤷 ♂️."},{"idx":3,"correct":true,"proposition":"Yellow fever vaccine","justification":""},{"idx":4,"correct":false,"proposition":"Cholera vaccine","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-4-qi-13","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"You decide to prescribe atovaquone-proguanil for malaria chemoprophylaxis for this 3-week trip. How long do you write on the prescription? (only one answer expected) ","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"3 weeks","justification":""},{"idx":1,"correct":true,"proposition":"4 weeks","justification":"Atovaquone-Proguanil: Length of stay + 1 week (daily dose)"},{"idx":2,"correct":false,"proposition":"5 weeks","justification":""},{"idx":3,"correct":false,"proposition":"6 weeks","justification":""},{"idx":4,"correct":false,"proposition":"7 weeks","justification":"Mefloquine: 1 week before + Length of stay + 3 weeks (weekly intake). \n\nDoxycycline: Length of stay + 4 weeks\/1 month (daily intake)"}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-4-qi-14","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"Upon her return from Côte d'Ivoire, the patient consults you again. She is doing well and the stay went well. She was even able to spend the last weekend in a bush camp. She describes rudimentary facilities with poor hygiene conditions, especially on bedding. Since her return, she has slept poorly due to pruritus of her forearms, wrists and fingers. One of her colleagues with whom she shared the same room has the same symptoms. On examination you see especially scratching lesions especially in interdigital spaces. She did not change personal care products. Which pathology do you think is most likely in this context? (only one answer expected)","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Atopic dermatitis","justification":""},{"idx":1,"correct":false,"proposition":"Pediculosis","justification":""},{"idx":2,"correct":true,"proposition":"Scabies","justification":""},{"idx":3,"correct":false,"proposition":"Larva Migrans","justification":""},{"idx":4,"correct":false,"proposition":"Contact dermatitis","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-4-qi-15","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"You mention a scabies that is confirmed by the visualization of parasites with a dermoscope. What do you recommend? (one or more correct answers) ","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Treatment with ivermectin","justification":""},{"idx":1,"correct":true,"proposition":"Treatment to be renewed at 7 days","justification":""},{"idx":2,"correct":true,"proposition":"Washing clothes at least 60 °C in a long cycle","justification":""},{"idx":3,"correct":true,"proposition":"Treatment at the same time of his colleague","justification":""},{"idx":4,"correct":false,"proposition":"2-week absence from work","justification":"Eviction from the community is up to 3 days after the start of treatment if common scabies (which seems to be the case here)."}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-5-qi-1","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"You notice the lesion opposite. You mention (one or more possible answers) ","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Squamous cell carcinoma","justification":"The lesion is regular. The patient is young. The area of attack is not classic."},{"idx":1,"correct":false,"proposition":"A canker sore","justification":""},{"idx":2,"correct":true,"proposition":"A hemorrhagic bubble","justification":""},{"idx":3,"correct":false,"proposition":"A bite","justification":""},{"idx":4,"correct":false,"proposition":"An angioma","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-5-qi-2","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"This is an oral hemorrhagic bubble. Given this lesion, which etiology is most likely? ","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Severe thrombocytopenia","justification":""},{"idx":1,"correct":false,"proposition":"Willebrand disease","justification":"Willebrand disease is a pathology of primary hemostasis that is accompanied by a normal platelet count. This is a possible etiology but unlikely given the age of the patient."},{"idx":2,"correct":false,"proposition":"Hemophilia","justification":""},{"idx":3,"correct":false,"proposition":"Vitamin K deficiency","justification":""},{"idx":4,"correct":false,"proposition":"Protein C deficiency","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-5-qi-3","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"You mention severe thrombocytopenia. What other bleeding signs are you looking for? (one or more possible answers)","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"A purpura","justification":"Purpura will then be thrombocytopenic: petechial, mucocutaneous, non-infiltrated, on the trunk and upper limbs as well as on the lower limbs."},{"idx":1,"correct":true,"proposition":"Gingivorragies","justification":""},{"idx":2,"correct":false,"proposition":"Hemarthrosis","justification":"Hemarthrosis is deep bleeding. It therefore evokes a pathology of coagulation."},{"idx":3,"correct":true,"proposition":"An epistaxis","justification":""},{"idx":4,"correct":true,"proposition":"A melena","justification":"Melena testifies to mucosal involvement, which is readily found in thrombocytopenia."}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-5-qi-4","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"On examination, you actually find purpura. What are the expected characteristics of purpura in this context? (one or more possible answers) ","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Painful","justification":""},{"idx":1,"correct":false,"proposition":"Necrotic","justification":""},{"idx":2,"correct":true,"proposition":"Petechial","justification":""},{"idx":3,"correct":false,"proposition":"Infiltrated","justification":""},{"idx":4,"correct":true,"proposition":"Associated with bruising","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-5-qi-5","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"What first-line exams will you request? (one or more possible answers)","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Complete blood count","justification":"We want to know hemoglobin. Be careful, the NFS does not provide information on the platelets (it is the NFS-P that counts the platelets!)."},{"idx":1,"correct":false,"proposition":"INR","justification":"Bleeding disorders are not suspected."},{"idx":2,"correct":false,"proposition":"TP, TCA, fibrinogen","justification":"Bleeding disorders are not suspected."},{"idx":3,"correct":false,"proposition":"D-dimer","justification":"We have no arguments for a potential DICV here."},{"idx":4,"correct":false,"proposition":"Reticulocytes","justification":"It will be asked if there is anemia."}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-5-qi-6","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"The CBC shows: red blood cells 2.24 T\/L, hemoglobin 76 g\/L, hematocrit 22.1%, MCV 98.7 fL, MCDC 34.4 g\/dL, leukocytes 1.3 G\/L, neutrophils 0.4 G\/L, lymphocytes 0.5 G\/L, monocytes 0.05 G\/L, blasts 0.35 G\/L, platelets 9 G\/L, reticulocytes 45 T\/L. Describe this NFS: ","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Neutropenia","justification":"neutrophils 0.4 G\/L when normal is > 1.5 G\/L"},{"idx":1,"correct":false,"proposition":"Hyperlymphocytosis","justification":"lymphocytes 0.5 G\/L when normal is > 1.5 G\/L"},{"idx":2,"correct":true,"proposition":"Thrombocytopenia","justification":"9 G\/L blisters with a normal > 150 G\/L"},{"idx":3,"correct":true,"proposition":"Normochrome anemia","justification":"Normochrome because CCMH between 32 and 36"},{"idx":4,"correct":false,"proposition":"Regenerative anemia","justification":"reticulocytes 45 T\/L while we speak of regenerative above 120-150."}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-5-qi-7","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"What diagnoses do you mention? (one or more possible answers) ","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Idiopathic bone marrow suppression","justification":""},{"idx":1,"correct":false,"proposition":"Aggressive lymphoma","justification":""},{"idx":2,"correct":false,"proposition":"Immunological thrombocytopenic purpura","justification":""},{"idx":3,"correct":true,"proposition":"Acute leukemia","justification":"The circulating blasts direct us directly to leukemia."},{"idx":4,"correct":false,"proposition":"Chronic myeloid leukemia","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-5-qi-8","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"You receive the hemostasis assessment. It shows: TP at 50%, TCA ratio 1.1, fibrinogen 0.88 g \/ l. How do you complete the hemostasis assessment? (one or more possible answers) ","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The determination of D-dimer","justification":"The TP is decreased, the TCA begins to increase, the fibrinogen is low 👉 red alert CIVD! The dosage of D-Dimer will allow us to base the diagnosis."},{"idx":1,"correct":false,"proposition":"The search for circulating anticoagulant","justification":""},{"idx":2,"correct":true,"proposition":"Determination of factor V","justification":"The TP is low, so factor VII is decreased. The determination of factor V will allow us to know if the decrease in factor VII comes from the liver (hepatocellular insufficiency) or from the synthesis of vitamin-dependent factors (X, IX, VII, II)."},{"idx":3,"correct":false,"proposition":"Anti-Xa activity","justification":""},{"idx":4,"correct":false,"proposition":"Determination of factor VIII","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-5-qi-9","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"You suspect acute myelogenous leukemia. You perform a myelogram. What are you waiting for? (one or more possible answers) ","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Poor marrow","justification":""},{"idx":1,"correct":true,"proposition":"The presence of more than 20% of myeloblasts","justification":""},{"idx":2,"correct":false,"proposition":"An increase in the number of myelocytes and metamyelocytes","justification":"Myelocytes and metamyelocytes are greatly reduced"},{"idx":3,"correct":true,"proposition":"Decreased or absent megakaryocytes","justification":""},{"idx":4,"correct":true,"proposition":"The presence of blasts with Auer bodies","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-5-qi-10","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"Mr. R. does have acute myelogenous leukemia. What should you do? (one or more possible answers)","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Emergency hospitalization","justification":""},{"idx":1,"correct":true,"proposition":"Protective Custody","justification":""},{"idx":2,"correct":true,"proposition":"A multidisciplinary consultation meeting to decide on therapeutic conduct","justification":""},{"idx":3,"correct":true,"proposition":"Perform an ad consultation","justification":""},{"idx":4,"correct":true,"proposition":"Apply for ALD","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-5-qi-11","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"Mr. R.'s file was presented in PCR, which offers him to participate in a randomized phase therapeutic protocol. He is given information with a consent form. Who should sign it? (one or more possible answers)","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The patient","justification":""},{"idx":1,"correct":true,"proposition":"The local investigating physician","justification":"There are two signatures: that of the patient and that of his investigator."},{"idx":2,"correct":false,"proposition":"The intern in charge of the patient","justification":""},{"idx":3,"correct":false,"proposition":"The support person","justification":""},{"idx":4,"correct":false,"proposition":"The pharmacist who dispenses the study products","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-5-qi-12","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"Treatment is started and he needs a red blood cell transfusion. What biological tests should be performed before transfusion? (one or more possible answers) ","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"ABO Rhesus Group","justification":""},{"idx":1,"correct":true,"proposition":"Rhesus-KEL phenotyping","justification":""},{"idx":2,"correct":true,"proposition":"Irregular agglutinin (RAI) testing","justification":""},{"idx":3,"correct":false,"proposition":"EBV Serology","justification":""},{"idx":4,"correct":false,"proposition":"CMV Serology","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-5-qi-13","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"Mr. R.'s uncle was infected during a transfusion in 1984. Mr. R. therefore wished to know what checks had been carried out on the red blood cells. Which of the following are true? (one or more possible answers) ","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The products are all leukocyte-free","justification":""},{"idx":1,"correct":false,"proposition":"The products are all irradiated","justification":"For the premature, for the patient in SCID (and not DICV), ..."},{"idx":2,"correct":true,"proposition":"Products are tested for HIV","justification":"HIV1 and 2"},{"idx":3,"correct":true,"proposition":"Products are tested for hepatitis B and C","justification":""},{"idx":4,"correct":false,"proposition":"Products are tested for CMV","justification":"The products are tested for HIV, HTLV, HCV, HBV, and syphilis."}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-5-qi-14","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"What are the legal provisions for transfusion? (one or more possible answers) ","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The nurse must verify the conformity of the product received","justification":""},{"idx":1,"correct":true,"proposition":"A doctor must be available quickly","justification":""},{"idx":2,"correct":false,"proposition":"Pellets must be transfused within one hour of arrival in the department","justification":"Within 6 hours"},{"idx":3,"correct":true,"proposition":"The nurse checks the identity match between the patient and the group card","justification":""},{"idx":4,"correct":true,"proposition":"The nurse checks the match between the group card and the cap pocket","justification":"The famous ultimate bedside test."}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-5-qi-15","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"You prescribe the transfusion of 2 phenotyped red blood cells. The nurse performs the test on a test cardboard before the transfusion. The result is: {pos = presence of agglutinates, neg = absence of agglutinates}. Which propositions are true? (one or more possible answers)","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The patient is group A","justification":"The card contains anti-A antibodies. They react with the patient's 👉 blood it is group 🅰 ."},{"idx":1,"correct":false,"proposition":"The patient is Rhesus positive","justification":""},{"idx":2,"correct":false,"proposition":"The red blood cell group is identical to that of the patient","justification":""},{"idx":3,"correct":true,"proposition":"The red blood cell is compatible with the patient","justification":""},{"idx":4,"correct":true,"proposition":"The patient can be transfused without further prior examination","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-6-qi-1","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"In view of this clinical picture, which is (are) the diagnostic hypothesis(s) to evoke? ","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Fracture of the upper end of the femur","justification":"It would then be Garden 2."},{"idx":1,"correct":true,"proposition":"Fracture of the sacrum","justification":"The patient's symptoms are: foot levator\/lowering deficit, electrical pain + paresthesia of the right lower limb. These symptoms can be part of the nosological framework of damage to the L5-S1 roots, following a fracture of the sacrum or femur."},{"idx":2,"correct":false,"proposition":"Coxofemoral dislocation","justification":"Statement: 'The inspection does not find a vicious attitude of the lower limb.'"},{"idx":3,"correct":true,"proposition":"Adductor rupture","justification":"Trauma in abduction 👉 possible tearing of the adductors."},{"idx":4,"correct":false,"proposition":"Removal of the distal insertion of the iliopsoas","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-6-qi-2","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"Which exam(s) should I request in the first line?","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"X-ray of the front pelvis","justification":""},{"idx":1,"correct":true,"proposition":"X-ray of the thoracolumbar spine","justification":"She probably fell on her back and she has a pain in the lower 👉 limb lower lumbar vertebral fracture?"},{"idx":2,"correct":false,"proposition":"Thoraco-abdomino-pelvic CT scan","justification":""},{"idx":3,"correct":false,"proposition":"MRI of the pelvis","justification":""},{"idx":4,"correct":false,"proposition":"Ultrasound of the coxofemoral joint","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-6-qi-3","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"After a 2-hour decubitus rest in the emergency room, the patient wants to get back on her feet. She says she finds her right leg and foot still numb. She still can't lift or extend her foot. X-rays of the pelvis and thoracolumbar spine are performed. Given the clinical and radiological evidence available for this patient, what is the most likely diagnostic hypothesis? ","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A fracture of the spine","justification":"No fractures are visualized"},{"idx":1,"correct":false,"proposition":"A fracture of an ischiopubic branch","justification":"No fractures are visualized"},{"idx":2,"correct":false,"proposition":"A fracture of the upper end of the femur","justification":"No fractures are visualized"},{"idx":3,"correct":false,"proposition":"Damage to the obturator nerve","justification":"This nerve arises from the L2, L3 and L4 roots of the lumbar plexus. His sensory-motor innervation stops at the knee."},{"idx":4,"correct":true,"proposition":"Damage to the sciatic nerve","justification":"This corresponds to the symptomatology."}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-6-qi-4","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"On X-rays, no fractures were observed. Nerve damage has been suggested. The patient was discharged from the emergency room the same day and you will see her at home 3 days after her fall. On inspection, you notice visible skin signs in the following photo. On clinical examination, the patient complains of having a cotton leg and right foot and localized pain in the sole of the right foot. The right patellar reflex is present, the right Achilles absent while it is present on the left. In distality, there is difficulty raising and lowering the tip of the right foot. Motor testing during knee extension, abduction and right hip extension are possible against resistance and are normal. You notice weakness in the flexion of the leg on the right thigh. She has hypoaesthesia of her right leg. There is no vesico-sphincter disorder. Given the clinical evidence you have, what type(s) of neurological impairment(s) can you discuss? ","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Monoradiculopathy","justification":"The involvement of a single root (L5 or S1) does not explain all the symptomatology. The infringement is therefore more distorted."},{"idx":1,"correct":false,"proposition":"Polyradiculopathy","justification":"The involvement of several roots would give a more proximal symptomatology."},{"idx":2,"correct":true,"proposition":"Monotroncular involvement","justification":"Absent right Achilles reflex (carried by the root S1) + difficulty raising and lowering the tip of the foot (involvement of the fibular nerve, branch of the sciatic nerve, which comes from the root L5) = involvement of the sciatic nerve = monotroncular involvement."},{"idx":3,"correct":false,"proposition":"Incomplete paraparesis","justification":"Paraparesis is bilateral. However, the symptoms here are one-sided."},{"idx":4,"correct":false,"proposition":"Cauda equina syndrome","justification":"No sphincter bladder disorders, no proximal involvement, no arguments 😅."}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-6-qi-5","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"Three days after the trauma, in the context of sciatic monotroncular involvement, which examination would be most likely to change the management of this patient? (only one answer expected) ","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A lumbar spinal CT scan","justification":""},{"idx":1,"correct":false,"proposition":"Sacco-radiculography","justification":""},{"idx":2,"correct":false,"proposition":"A perineal electromyogram","justification":""},{"idx":3,"correct":false,"proposition":"An electromyogram of the lower limbs","justification":""},{"idx":4,"correct":true,"proposition":"An ultrasound of the right buttock and right thigh","justification":"The patient has a hematoma of the thigh, probably compressible 👉 we will try to see if this is really the case 😉"}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-6-qi-6","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"Ultrasound of the right buttock showed a hematoma that was evacuated because it compressed the sciatic nerve. You want to prescribe a right foot lifter-type technical aid. Which of the following regulatory elements for non-molded orthotics is(are) accurate:","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"They require a request for prior agreement","justification":""},{"idx":1,"correct":true,"proposition":"They are available from pharmacists","justification":""},{"idx":2,"correct":false,"proposition":"They are prescribed on a major appliance form.","justification":""},{"idx":3,"correct":true,"proposition":"They are prescribed on a simple prescription","justification":""},{"idx":4,"correct":false,"proposition":"They are fully reimbursed by the health insurance fund","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-6-qi-7","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"You decide to prescribe rehabilitation sessions on an outpatient basis at home. Among these elements, which is (are) mandatory on the prescription for the physiotherapist:","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Total number of sessions","justification":""},{"idx":1,"correct":true,"proposition":"The mention << at home>>","justification":""},{"idx":2,"correct":true,"proposition":"The region and\/or pathology to be treated","justification":""},{"idx":3,"correct":true,"proposition":"The mention << Masso-kinesitherapy>>","justification":""},{"idx":4,"correct":false,"proposition":"The physiotherapy technique used","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-6-qi-8","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"You follow your patient in regular consultation every month. Which of the following clinical or paraclinical elements is useful for monitoring recovery from this traumatic truncal nerve injury?","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Electromyogram","justification":"As for most peripheral nerve damage, the EMG will make it possible to follow the (potention of) evolution with the monitoring of the speeds \/ amplitudes of the impulse."},{"idx":1,"correct":true,"proposition":"Motor clinical testing","justification":""},{"idx":2,"correct":true,"proposition":"Sensory clinical testing","justification":""},{"idx":3,"correct":false,"proposition":"Ultrasound","justification":""},{"idx":4,"correct":false,"proposition":"Muscle electrostimulation","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-6-qi-9","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"You see the patient again in consultation 3 months after the initial trauma. She always has an abnormal gait. In the oscillating phase of walking on flat ground, the tip of the right foot is constantly lowered, it raises the knee higher than it does at the same phase on the left side. Which of these statements is (are) accurate?","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"This is a waddling approach","justification":""},{"idx":1,"correct":true,"proposition":"This is a steppage approach","justification":""},{"idx":2,"correct":false,"proposition":"This is a hot step","justification":""},{"idx":3,"correct":false,"proposition":"This is an earlier greeting","justification":""},{"idx":4,"correct":false,"proposition":"This is a mowing process","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-6-qi-10","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"The patient is increasingly anxious about walking due to her right sciatica neurological injury. She clings the tip of her right foot into a loose carpet at home, as she walked through a dark hallway. She stumbles and falls again. She can no longer support the right side because of pain. Here is the x-ray of the pelvis taken in the emergency room. What can you say from the X-ray? (one or more correct answers) ","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Right sacrarian-iliac disjunction","justification":""},{"idx":1,"correct":false,"proposition":"Garden 3 fracture of the right femoral neck","justification":""},{"idx":2,"correct":true,"proposition":"Right ischiopubic branch fracture","justification":""},{"idx":3,"correct":false,"proposition":"Right pertrochanteric fracture","justification":""},{"idx":4,"correct":false,"proposition":"Fracture of the right little trochanter","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-6-qi-11","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"Which of the various factors that may have contributed to this patient's fall, which do you consider to be an intrinsic factor(s) of falling? ","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Faulty lighting","justification":"Environmental factor"},{"idx":1,"correct":true,"proposition":"Damage to the sciatic nerve","justification":""},{"idx":2,"correct":false,"proposition":"The poorly fixed carpet","justification":"Environmental factor"},{"idx":3,"correct":true,"proposition":"Age-related macular degeneration","justification":""},{"idx":4,"correct":false,"proposition":"The orthosis (calf-plant lifter) ineffective","justification":"Walking disorder = predisposing factor"}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-6-qi-12","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"Which of the following is considered an activity limitation in this patient? ","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A decrease in the range of motion of the right hip","justification":"Impairment"},{"idx":1,"correct":false,"proposition":"Pain when walking","justification":"Impairment"},{"idx":2,"correct":true,"proposition":"Difficulty climbing stairs","justification":""},{"idx":3,"correct":false,"proposition":"A sensory disorder of the sole of the right foot","justification":"Impairment"},{"idx":4,"correct":true,"proposition":"Reduced walking performance","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-6-qi-13","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"You want to improve the patient's balance and walking disorders. Which of the following health professionals will contribute to the improvement of these symptoms?","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Orthoptist"},{"idx":1,"correct":false,"proposition":"Speech therapist"},{"idx":2,"correct":true,"proposition":"Podo-orthotist"},{"idx":3,"correct":true,"proposition":"Physiotherapist"},{"idx":4,"correct":true,"proposition":"Psychomotor therapist"}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-6-qi-14","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"Given the patient's age, which insurance organization(s) will contribute to the patient's care?","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Supplementary health fund","justification":""},{"idx":1,"correct":true,"proposition":"Caisse primaire d'assurance maladie","justification":""},{"idx":2,"correct":false,"proposition":"Communal social action services","justification":""},{"idx":3,"correct":false,"proposition":"Aid for the autonomy of the departmental council","justification":"APA is not insurance 😉"},{"idx":4,"correct":false,"proposition":"National Fund for Solidarity and Autonomy"}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-7-qi-1","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"Among the following acrosyndromes, and at this stage of the semiological description, which one (or which) is (are) compatible with the clinical picture reported by Mrs. X.? ","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Acrocyanosis","justification":""},{"idx":1,"correct":true,"proposition":"Raynaud's phenomenon","justification":""},{"idx":2,"correct":true,"proposition":"Erythermalgia","justification":""},{"idx":3,"correct":false,"proposition":"Chilblains","justification":""},{"idx":4,"correct":false,"proposition":"Digital necrosis","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-7-qi-2","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"She tells you that these episodes are clearly triggered by the cold, and presents you at the consultation a photograph taken during one of these episodes. With this new information, the possible diagnosis(s) is: ","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Secondary Raynaud's phenomenon","justification":""},{"idx":1,"correct":true,"proposition":"Raynaud's disease","justification":""},{"idx":2,"correct":false,"proposition":"Erythermalgia","justification":""},{"idx":3,"correct":false,"proposition":"Fine fibre neuropathy","justification":""},{"idx":4,"correct":false,"proposition":"Acrocyanosis","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-7-qi-3","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"You are diagnosed with Raynaud's phenomenon. What elements are to be looked for during the interrogation? (one or more expected answers) ","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"A cyanic phase","justification":""},{"idx":1,"correct":true,"proposition":"Damage to the toes","justification":""},{"idx":2,"correct":true,"proposition":"Thumb damage","justification":""},{"idx":3,"correct":true,"proposition":"A painful erythematous phase","justification":""},{"idx":4,"correct":false,"proposition":"Worsening when taking paracetamol","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-7-qi-4","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"On physical examination of the patient, you note: \n\n- whitening of the hand after compression of the ulnar and radial arteries and << pumping maneuvers >>, then obtaining a recoloration of the hand in 3 seconds following the relaxation of the ulnar artery; and in 4 seconds after the relaxation of the radial artery; \n\n- the absence of paresthesias of the fingers at the percussion of the anterior surface of the wrist or during the forced flexion of the wrist. \n\nThe patient's physical examination favours (one or more correct answers)","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"From a normal Allen maneuver","justification":"The cut-off is 7-10 seconds."},{"idx":1,"correct":false,"proposition":"Thrombosis of the radial artery","justification":""},{"idx":2,"correct":false,"proposition":"A positive Tinel sign","justification":""},{"idx":3,"correct":false,"proposition":"From compression of the median nerve to carpal tunnel","justification":""},{"idx":4,"correct":false,"proposition":"A positive Phalen sign","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-7-qi-5","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"What semiological element(s) are you looking for in favor of a secondary Raynaud's phenomenon? ","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Dry oral or ocular syndrome","justification":""},{"idx":1,"correct":true,"proposition":"Photosensitivity","justification":""},{"idx":2,"correct":true,"proposition":"Muscle pain","justification":""},{"idx":3,"correct":true,"proposition":"Scleroditactyly","justification":""},{"idx":4,"correct":true,"proposition":"Telangiectasias","justification":"Telangiectasias would be part of cutaneous scleroderma (CREST syndrome)."}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-7-qi-6","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"When questioned by Mrs. X., she explains that these symptoms began around the age of 30, and occur every winter. She has no notable personal history, but her sister and mother have the same type of clinical manifestations. Thumbs are spared. It does not describe any other symptoms. On physical examination, you do not find trophic disorder, sclerodactyly or telangiectasia, peripheral pulses are perceived in all 4 limbs, and you do not notice audible murmur on auscultation of arterial pathways. Which clinical element(s) is compatible with Raynaud's disease (essential Raynaud's phenomenon)? ","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The age of onset of symptoms","justification":"We start to ask ourselves questions after 35 years."},{"idx":1,"correct":true,"proposition":"Family history","justification":""},{"idx":2,"correct":true,"proposition":"Winter upsurge","justification":""},{"idx":3,"correct":true,"proposition":"Lack of thumb involvement","justification":""},{"idx":3,"correct":true,"proposition":"Bilateral Achievement","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-7-qi-7","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"In the clinical situation of Mrs. X., which additional examination(s) do you prescribe? ","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"X-ray of the spine from the front centered on C7","justification":""},{"idx":1,"correct":false,"proposition":"Chest x-ray from the front","justification":""},{"idx":2,"correct":false,"proposition":"Ultrasound-Doppler of the arteries of the upper limbs","justification":""},{"idx":3,"correct":false,"proposition":"Cryoglobulinemia detection","justification":""},{"idx":4,"correct":true,"proposition":"Antinuclear antibody testing","justification":"As well as a capillaroscopy."}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-7-qi-8","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"Antinuclear antibodies are 1\/80. You retain the diagnosis of essential Raynaud's phenomenon (Raynaud's disease) and propose symptomatic management. Five years later, Mrs. X. is referred to you by her doctor for a fever that has been evolving for 4 weeks. This fever is irregular, oscillating with a temperature of 37.9 ° C in the morning but higher in the evening, can rise up to 39 ° C and associated with sweating. Mrs. X. is tired, she has lost 2 kg since the beginning of this fever. She has no other symptoms. She lives in an urban setting, has never travelled abroad, and does not take any treatment. The clinical picture currently presented by the patient is compatible with: (one or more exact answers) ","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"A solid cancer","justification":""},{"idx":1,"correct":false,"proposition":"A familial Mediterranean fever","justification":"The picture does not stick: it is rather that of a teenager."},{"idx":2,"correct":true,"proposition":"An infectious disease","justification":""},{"idx":3,"correct":true,"proposition":"Lymphoma","justification":""},{"idx":4,"correct":true,"proposition":"Takayasu's disease","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-7-qi-9","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"In the clinical situation of the patient, what biological abnormality(s) would be suggestive of an inflammatory syndrome? ","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Increased albumin","justification":"Increase in all proteins except transport proteins: albumin, transferrin and transtyretrin."},{"idx":1,"correct":false,"proposition":"Decreased haptoglobin","justification":""},{"idx":2,"correct":true,"proposition":"Increased fibrinogen","justification":""},{"idx":3,"correct":true,"proposition":"Decreased transferrin","justification":""},{"idx":4,"correct":true,"proposition":"Increase in alpha2-globulins","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-7-qi-10","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"On physical examination of the patient in the supine position, you perceive a mass of the left hypochondrium lowering on deep inhalation. Which of the following proposals do you think is accurate given this new clinical element?","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"This clinical finding is common in a young, thin patient","justification":""},{"idx":1,"correct":false,"proposition":"This clinical finding makes an infectious cause less likely","justification":"Many infections can be accompanied by splenomegaly: mononucleosis syndrome (HIV, CMV, toxoplasmosis, ...), endocarditis, hepatitis, malaria, ..."},{"idx":2,"correct":false,"proposition":"This clinical finding makes an autoimmune cause less likely ","justification":"Lupus, sarcoidosis and rheumatoid arthritis (to name only the less rare) are often accompanied by splenomegaly."},{"idx":3,"correct":true,"proposition":"This clinical finding can be observed in cases of liver disease","justification":"👉 This is a sign of portal hypertension."},{"idx":4,"correct":true,"proposition":"This clinical finding should suggest a haemological pathy","justification":"Including lymphomas."}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-7-qi-11","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"On cardiac auscultation of Mrs. X., you perceive a systolic murmur at 2\/6. This heart murmur was not known until now. There is no associated diastolic murmur, heart sounds are regular, there are no signs of associated heart failure. You suspect infective endocarditis. What element(s) are you looking for to support your suspected diagnosis?","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Purpura of the lower limbs","justification":"Vascular pupura is an immunological manifestation"},{"idx":1,"correct":true,"proposition":"Purplish nodules of the pulp of the fingers ","justification":"This is called Osler's False Panaris (pathognomonic sign of infective endocarditis)."},{"idx":2,"correct":true,"proposition":"Proteinuria the urine strip","justification":""},{"idx":3,"correct":false,"proposition":"Distal paresthesias of the lower limbs","justification":""},{"idx":4,"correct":false,"proposition":"Red and painful eye","justification":"Roth's nodules can be observed at the back of the eye, but without affecting the anterior chamber."}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-7-qi-12","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"At this stage of the treatment, which examination(s) do you think are justified?","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Angiotensin-converting enzyme assay","justification":""},{"idx":1,"correct":false,"proposition":"PET-scanner"},{"idx":2,"correct":true,"proposition":"Blood"},{"idx":3,"correct":false,"proposition":"Antibodiesanti-pegtidescitrullinated (anti-CCP)","justification":""},{"idx":4,"correct":true,"proposition":"Transthoracic cardiac ultrasound","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-7-qi-13","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"Three blood cultures with aero-anaerobic cultures remain sterile, the good quality transthoracic cardiac ultrasound is normal, showing no vegetation image or significant valve abnormality. Which of the following proposals do you think is correct? ","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"The realization of a trans-esophageal cardiac ultrasound is justified","justification":"The description of ETT is very reassuring. Blood cultures are negative. It is lawful to stop there."},{"idx":1,"correct":true,"proposition":"The realization of a thoraco-abdomino-pelvic CT scan is justified","justification":""},{"idx":2,"correct":true,"proposition":"The realization of viral serologies (HIV and EBV) is justified","justification":""},{"idx":3,"correct":false,"proposition":"A therapeutic test with corticosteroids is justified","justification":""},{"idx":4,"correct":false,"proposition":"A therapeutic test with antibiotics is justified","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-7-qi-14","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"HIV serology is negative, and EBV serology supports ancient immunity. A thoraco-abdomino-pelvic CT scan shows supracentimetric mediastinal lymphadenopathy and splenomegaly. Which of the following tests do you think is the most relevant way to advance in the diagnostic investigation of the patient? (only one answer expected) ","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Search for anti-neutrophil cytoplasmic antibodies (ANCA)","justification":""},{"idx":1,"correct":false,"proposition":"lmmunophenotyping lymphocyte","justification":""},{"idx":2,"correct":false,"proposition":"Plasma LDH determination","justification":""},{"idx":3,"correct":false,"proposition":"Splenic biopsy","justification":"A spleen is not biopsied because there is too great a risk of bleeding."},{"idx":4,"correct":true,"proposition":"Mediastinal lymph node biopsy","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-7-qi-15","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"A diagnosis of diffuse large cell B-cell lymphoma is made by a lymph node biopsy performed by mediastinoscopy. An implantable chamber is placed and immunochemotherapy treatment with R-CHOP (rituximab - cyclophosphamide, hydroxydoxorubicin, vincristine and prednisone) is started. \n\nWhile the first 2 treatment cycles were uncomplicated, the patient ° presents on Day 10 of the 3rd treatment cycle a fever at 39 ° C with chills. You see her in an emergency consultation. Blood pressure is 130\/70 mmHg, heart rate is 95\/minute. The patient does not have a neurological disorder, the skin examination, especially with regard to the implantable chamber is normal, there is no obvious functional or physical respiratory, digestive or urinary sign. Your physical exam is normal. A blood count taken in town the same morning shows the following results: white blood cells 1.8 G\/L, hemoglobin 104 g\/L, mean corpuscular volume 85 fL, platelets 97 G\/L, leukocyte formula: neutrophils 0.4 G\/L eosinophilic polynuclear 0.1 G\/L, basophilic polynuclear 0.9 G\/L, lymphocytes 0.9 G\/L, monocytes 0.3 G\/L. What examination(s) do you perform before starting antibiotic therapy in your patient? ","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Aspergillary antigenemia","justification":""},{"idx":1,"correct":false,"proposition":"Blood smear looking for Jolly's bodies","justification":""},{"idx":2,"correct":true,"proposition":"Blood cultures on the periphery and on the central venous catheter","justification":""},{"idx":3,"correct":false,"proposition":"Chest X-ray","justification":""},{"idx":4,"correct":false,"proposition":"Thoraco-abdominal CT scan","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-7-qi-16","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"Outpatient care is offered. Treatment with amoxicillin\/clavulanic acid + ciprofloxacin is started urgently. The fever disappears within 24 hours. Samples taken before the start of treatment remain sterile, and treatment is continued for 7 days. \n\nThree weeks later, the patient sees you again because of the onset of a fever at 39.5°C associated with the next rash. Which of the following may be present in your patient in case of drug reaction syndrome with eosinophilia and systemic signs (DRESS)? (one or more expected answers)","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Extensive skin detachment","justification":""},{"idx":1,"correct":true,"proposition":"eosinophilia> 1500\/mm3","justification":""},{"idx":2,"correct":true,"proposition":"elevation of transaminases with decrease of TP","justification":""},{"idx":3,"correct":true,"proposition":"acute renal failure","justification":""},{"idx":4,"correct":true,"proposition":"diffuse lymphadenopathy","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-8-qi-1","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"Which additional examination should be carried out first at this stage?","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Chest x-ray from the front","justification":""},{"idx":1,"correct":false,"proposition":"Echocardiography","justification":""},{"idx":2,"correct":false,"proposition":"Chest CT scan","justification":""},{"idx":3,"correct":true,"proposition":"Electrocardiogram","justification":""},{"idx":4,"correct":false,"proposition":"Arterial blood gas","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-8-qi-2","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"In the event of a myocardial infarction, which early life-threatening complication should you keep in mind as a priority during your initial management? ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Cardiogenic shock","justification":"It is less early, less serious, and less common than ventricular fibrillation."},{"idx":1,"correct":false,"proposition":"Septal rupture","justification":""},{"idx":2,"correct":false,"proposition":"Pericarditis","justification":""},{"idx":3,"correct":true,"proposition":"Ventricular fibrillation","justification":""},{"idx":4,"correct":false,"proposition":"Intraventricular thrombosis ","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-8-qi-3","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"The interrogation reveals that the pain is chronic, evolving crescendo for 3 months. The electrocardiogram performed immediately does not show an argument in favor of acute coronary syndrome. On physical examination, you find dyspnea at the slightest effort with appearance of edema of the bilateral lower limbs, a gain of 6 kg in 10 days as well as jugular turgor with hepatojugular reflux. The life constants are: BP 95\/65 mmHg, heart rate 112 beats\/min, OPS 98% ambient air, temperature 36.6 °C.  What are the two most likely diagnoses compatible with this clinical picture? ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Acute edema of the lung","justification":"There would be no signs of right heart failure (OMI, TJ, RHJ)."},{"idx":1,"correct":true,"proposition":"Pericardial tamponade","justification":""},{"idx":2,"correct":false,"proposition":"Myocardial infarction","justification":""},{"idx":3,"correct":true,"proposition":"Recurrent pulmonary embolisms","justification":""},{"idx":4,"correct":false,"proposition":"Aortic dissection","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-8-qi-4","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"By resuming your physical examination, the intern reports observing a paradoxical pulse. Which of the following proposals corresponds to the description of a paradoxical pulse? ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Pulse attenuated one out of two heartbeats","justification":""},{"idx":1,"correct":false,"proposition":"Expiratory pulse depression","justification":""},{"idx":2,"correct":true,"proposition":"Inspiratory pulse depression","justification":"Sign of tamponade."},{"idx":3,"correct":false,"proposition":"Pulse perception after the second heart sound","justification":""},{"idx":4,"correct":false,"proposition":"Increased pulse sitting leaning forward","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-8-qi-5","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"Inspiratory pulse depression confirms the paradoxical pulse. In this context, you ask for a front chest X-ray and echocardiography. What anomaly(s) do you identify on this shot taken in bed ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Right pleural effusion","justification":"We distinguish the pleural cul de sac."},{"idx":1,"correct":true,"proposition":"Cardiomegaly","justification":""},{"idx":2,"correct":false,"proposition":"Aspect of double aortic contour","justification":""},{"idx":3,"correct":false,"proposition":"Protrusion of the lower left arch of the cardiac silhouette","justification":"We asked a radiology PU-PH for his opinion on these two proposals. His answer: the protrusions of the heart arches correspond to cardiomegaly, but only when it is the heart that exceeds its usual size. We can not speak strictly of protrusion here, since the paradoxical pulse directs you to a pericardial effusion. "},{"idx":4,"correct":false,"proposition":"Protrusion of the lower right arch of the cardiac silhouette","justification":"We asked a radiology PU-PH for his opinion on these two proposals. His answer: the protrusions of the heart arches correspond to cardiomegaly, but only when it is the heart that exceeds its usual size. We can not speak strictly of protrusion here, since the paradoxical pulse directs you to a pericardial effusion. "}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-8-qi-6","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"On echocardiography, there is a circumferential pericardial effusion of great abundance with hemodynamic impact and a scalloped appearance of the serosa. You retain the diagnosis of pericardial tamponade. What element(s) is (are) involved in the pathophysiology of tamponade? ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Decreased systolic ejection volume of the left ventricle","justification":""},{"idx":1,"correct":true,"proposition":"Compression of the right ventricle","justification":""},{"idx":2,"correct":false,"proposition":"Compensatory bradycardia","justification":""},{"idx":3,"correct":true,"proposition":"Increased intrapericardial pressures","justification":""},{"idx":4,"correct":false,"proposition":"Shunt effect","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-8-qi-7","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"What is (are) the therapeutic measure(s) to be applied urgently in front of this tamponade? ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Pericardial drainage","justification":""},{"idx":1,"correct":false,"proposition":"Intravenous infusion of nitrates","justification":"It's not an OAP"},{"idx":2,"correct":false,"proposition":"Infusion of catecholamines (dobutamine or noradrenaline)","justification":""},{"idx":3,"correct":false,"proposition":"Volume depletion","justification":"It's not an OAP"},{"idx":4,"correct":false,"proposition":"Parenteral anticoagulation","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-8-qi-8","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"You transfer the patient for emergency drainage to the cardiac surgery block. 1,000 mL of bloody fluid was punctured. The pathologist identifies the presence of tumor cells of adenocarcinomatous nature. She was then admitted to intensive care. Which underlying primary tumor can you end up with a significant probability? (one or more correct answer(s)) ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Breast cancer","justification":""},{"idx":1,"correct":false,"proposition":"Melanoma","justification":"It is not adenocarcinoma"},{"idx":2,"correct":true,"proposition":"Lung cancer","justification":""},{"idx":3,"correct":false,"proposition":"Cavum cancer","justification":"It is not adenocarcinoma"},{"idx":4,"correct":false,"proposition":"Cervical cancer","justification":"It is not adenocarcinoma"}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-8-qi-9","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"A chest CT scan identifies in addition to neoplastic pericarditis in particular: a left hilar tumor mass extending to the apico-dorsal segment of the culmen associated with homolateral mediastinal adenomegaly, bilateral pleural effusion. What is the stage of the disease?","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"1","justification":""},{"idx":0,"correct":false,"proposition":"2","justification":""},{"idx":0,"correct":false,"proposition":"3a","justification":""},{"idx":0,"correct":false,"proposition":"3b","justification":""},{"idx":0,"correct":true,"proposition":"4","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-8-qi-10","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"In the case of primary stage IV bronchial adenocarcinoma, what extension assessment do you request in the absence of a new symptom (one or more correct response(s))?","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Brain CT scan","justification":""},{"idx":1,"correct":false,"proposition":"Abdominopelvic CT scan","justification":""},{"idx":2,"correct":false,"proposition":"Bone scintigraphy","justification":""},{"idx":3,"correct":false,"proposition":"Panendoscopy","justification":""},{"idx":4,"correct":true,"proposition":"None","justification":"The tumour is stage IV (disseminated). The extension assessment has no therapeutic impact."}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-8-qi-11","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"What is the reference oncological treatment for this stage IV bronchial cancer (one or more possible response(s))? ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Pneumo-pleuro-pericardectomy","justification":""},{"idx":1,"correct":false,"proposition":"Mediastinal radiation therapy","justification":""},{"idx":2,"correct":true,"proposition":"Systemic chemotherapy","justification":""},{"idx":3,"correct":false,"proposition":"Intrapericardial chemotherapy","justification":""},{"idx":4,"correct":true,"proposition":"Supportive care","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-8-qi-12","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"The general condition being preserved, you retain an indication of systemic treatment of metastatic first-line associated with palliative care. What will you look for on the pathological report of pericardial drainage fluid to guide the choice of systemic treatment (one or more possible answers)? ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"EGFR activating mutation","justification":""},{"idx":1,"correct":true,"proposition":"Expression de PDL1","justification":""},{"idx":2,"correct":true,"proposition":"Mutation de BRAF","justification":""},{"idx":3,"correct":true,"proposition":"Translocation of ALK","justification":""},{"idx":4,"correct":false,"proposition":"Nothing in particular, chemotherapy being based on a doublet of conventional drugs","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-8-qi-13","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"In the absence of targetable molecular alteration and expression of PDL1, you retain the indication of chemotherapy with carboplatin \/ paclitaxel. What is(s) the main expected side effect(s) of carboplatin of which you inform the patient? ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Asthenia","justification":"the 2"},{"idx":1,"correct":true,"proposition":"Stomatitis","justification":"the 2"},{"idx":2,"correct":true,"proposition":"Cytopenia","justification":"the 2"},{"idx":3,"correct":true,"proposition":"Peripheral neuropathy","justification":"paclitaxel"},{"idx":4,"correct":false,"proposition":"Hearing loss","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-8-qi-14","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"Finally the situation is complicated with a DICD not allowing to start chemotherapy. You move towards exclusive palliative care and decide to hospitalize the patient in a palliative care unit. Regarding palliative care units (PHUs), what is(are) the exact statement(s)? ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Their mission is to admit patients in end-of-life situations and who present a complex situation of care","justification":""},{"idx":1,"correct":false,"proposition":"The essential criterion for a patient to be admitted to USP is that his survival is estimated at less than three months","justification":""},{"idx":2,"correct":true,"proposition":"The main objective of a USP treatment is to improve the patient's quality of life","justification":""},{"idx":3,"correct":true,"proposition":"Chemotherapy treatments can be continued even while the patient is hospitalized in USP","justification":""},{"idx":4,"correct":false,"proposition":"The visit of children under 10 years old is not allowed in USP","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-8-qi-15","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"After a few days of hospitalization in the palliative care unit, the situation, although precarious, stabilized and the patient expressed the wish to return home. What element(s) could jeopardize the organization of this return home? ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Physical or moral exhaustion of loved ones","justification":""},{"idx":1,"correct":false,"proposition":"The need for 3 electric syringes","justification":""},{"idx":2,"correct":true,"proposition":"A refusal of the family to consider death at home","justification":""},{"idx":3,"correct":false,"proposition":"The need for morphine treatment at a high dosage","justification":""},{"idx":4,"correct":true,"proposition":"A lack of mobilization of the attending physician","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-9-qi-1","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"What therapeutic care do you offer for this diabetes? (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"800 kcal\/d and low-carbohydrate diet","justification":""},{"idx":1,"correct":true,"proposition":"Low-calorie diet (30% reduction in current intake) and low in fast sugars","justification":""},{"idx":2,"correct":false,"proposition":"Metformin therapy","justification":"We always start with hygiene measures in type 2 diabetes."},{"idx":3,"correct":false,"proposition":"Treatment with slow insulin and basal bolus","justification":""},{"idx":4,"correct":true,"proposition":"Physical activity","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-9-qi-2","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"You recover the following balance: creatinine at 130 μmol \/ L or a glomerular filtration rate CKD-PPE estimated at 52 ml \/ min \/ 1.73 m ^2 \nUrine strip: protein three cross, red blood cells three cross, leukocytes negative, nitrites negative, ketone bodies negative. What biological tests are needed at this stage? (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Renin aldosterone dosage","justification":""},{"idx":1,"correct":true,"proposition":"Cytobacteriological examination of urine","justification":""},{"idx":2,"correct":true,"proposition":"24-hour proteinuria","justification":""},{"idx":3,"correct":false,"proposition":"Anti-neutrophil cytoplasmic antibodies (ANCA)","justification":""},{"idx":4,"correct":false,"proposition":"Anti-PLA2R antibodies","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-9-qi-3","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"The results are as follows: \nECBU: red blood cells at 80,000\/ml, leukocytes< 1000\/ml, negative culture over 24 h. \n24-hour proteinuria: 2.5 g\/d composed of 70% albumin. \nWhat are the additional examinations to be carried out in the face of these anomalies? (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":" Fundus","justification":""},{"idx":1,"correct":true,"proposition":"Vesicorenal ultrasound with arterial Doppler","justification":""},{"idx":2,"correct":false,"proposition":"Accessory salivary gland biopsy","justification":""},{"idx":3,"correct":false,"proposition":"Renal MRI angiography","justification":""},{"idx":4,"correct":false,"proposition":"Uroscanner","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-9-qi-4","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"The fundus finds arterial stiffness with sign of crossing without further lesion. Renal Doppler ultrasound finds normal-sized kidneys without dilation of the pyelocalicial cavities. There is a simple kidney cyst of 1 cm on the right and one of 4 mm on the left. The Doppler analysis is not very contributory given the morphotype of the patient but the radiologist indicates that he does not find an indirect sign for significant renal arterial stenosis. \nThere is a 12 mm tissue-like image at the lower bladder bottom. In addition, despite the appropriate hygiene measures, diabetes control is unsatisfactory and you start treatment with metformin at a dose of 500 mg at a frequency of 3 times \/ day. Given these results, what can be the causes of this hematuria (one or more correct answers)?","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Polycystic kidney disease","justification":""},{"idx":1,"correct":false,"proposition":"Diabetic glomerular nephropathy","justification":"Hematuria is not found in diabetic glomerular nephropathy"},{"idx":2,"correct":true,"proposition":"lgA nephropathy","justification":""},{"idx":3,"correct":true,"proposition":"Urothelial tumour","justification":"The ultrasound imagining orients us somewhat."},{"idx":4,"correct":true,"proposition":"Extramembranous glomerulonephritis","justification":"GEM can be accompanied by hematuria"}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-9-qi-5","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"What tests are needed to explore this hematuria at this stage? (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Puncture kidney biopsy","justification":""},{"idx":1,"correct":true,"proposition":"Bladder fibroscopy","justification":""},{"idx":2,"correct":true,"proposition":"Urinary cytology on fresh urine with histopathological examination","justification":""},{"idx":3,"correct":true,"proposition":"Uroscanner","justification":""},{"idx":4,"correct":false,"proposition":"Ascending urethrocystography and voiding","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-9-qi-6","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"You decide to do urinary cytology and bladder fibroscopy. \nRegarding the possible realization of the uroscanner in your patient, which proposals are accurate (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"This examination is contraindicated in this patient","justification":""},{"idx":1,"correct":true,"proposition":"Metformin should be stopped on the day of the exam","justification":"It will be reintroduced on Day 2."},{"idx":2,"correct":false,"proposition":"Hydration by glucose solute is to be expected before the examination","justification":""},{"idx":3,"correct":true,"proposition":"Oral hydration is to be expected before the examination","justification":""},{"idx":4,"correct":false,"proposition":"There is a risk of acute interstitial nephritis","justification":"There is a risk of acute tubular necrosis."}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-9-qi-7","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"The uroscanner did not find any other urothelial lesions. Cystoscopy confirmed the existence of the polyp and a transurethral resection of the bladder polyp was performed. Anatomical pathology has shown that it is a low-grade urothelial carcinoma pTa. What is the exact proposal regarding his tumor? (an expected response) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"It is an invasive tumor infiltrating the muscle","justification":"From T2"},{"idx":1,"correct":false,"proposition":"This is carcinoma in situ","justification":"Tis"},{"idx":2,"correct":false,"proposition":"It is a tumor infiltrating the chorion","justification":"T1"},{"idx":3,"correct":true,"proposition":"It is a non-invasive papillary tumour","justification":""},{"idx":4,"correct":false,"proposition":"It is an epidermoid tumor","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-9-qi-8","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"In the absence of diabetic retinopathy, you decide to perform a kidney biopsy. The pathology report is as follows: \n8 mm renal cortical fragment containing 12 glomeruli including 2 sclerotic glomeruli. \nThe remaining 10 glomeruli exhibit nodular mesangial expansion with thickening of the basement membranes. \nThere is moderate arteriolar hyalinosis and interstitial fibrosis affecting 20% of the parenchyma of the biopsy. \nThe coloration by Congo red is negative. \nThe immunofluorescence study does not find significant deposits in the glomeruli. \nWhat is the most likely diagnosis (only one response expected) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Pauciimmune glomerulonephritis","justification":""},{"idx":1,"correct":false,"proposition":"Nephroangiosclerosis","justification":""},{"idx":2,"correct":false,"proposition":"Renal amyloidosis","justification":""},{"idx":3,"correct":true,"proposition":"Diabetic glomerulosclerosis","justification":""},{"idx":4,"correct":false,"proposition":"Membranoproliferative glomerulonephritis","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-9-qi-9","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"Your patient therefore has diabetic glomerulosclerosis. Its renal function stabilizes at 135 μmol\/I (DFG CKD EPI = 50 ml\/min\/1.73 m^22). What is the stage of his chronic kidney disease? (an expected response) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Stage 2","justification":""},{"idx":1,"correct":true,"proposition":"Stage 3A","justification":""},{"idx":2,"correct":false,"proposition":"Stage 1","justification":""},{"idx":3,"correct":false,"proposition":"Stage 3B","justification":""},{"idx":4,"correct":false,"proposition":"Stage 4","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-9-qi-10","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"What are the treatment targets in this patient at this stage? (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Proteinuria < 0.5 g\/24 hours","justification":""},{"idx":1,"correct":false,"proposition":"Negativation of hematuria","justification":"Hematuria is not a nephrological cause. It comes from his tumor."},{"idx":2,"correct":false,"proposition":"Blood pressure less than or equal to 120\/70 mmHg","justification":""},{"idx":3,"correct":false,"proposition":"Protein intake less than 0.6 g\/kg\/day","justification":""},{"idx":4,"correct":true,"proposition":"Salt intake close to 6 g\/24 hours","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-9-qi-11","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"Which of the following molecules can be prescribed as a first-line treatment for this patient for high blood pressure? (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"ACE inhibitor (ACE inhibitor)","justification":""},{"idx":1,"correct":true,"proposition":"Angiotensin II receptor antagonist (ARA2)","justification":""},{"idx":2,"correct":true,"proposition":"Angiotensin-thiazide receptor antagonist association","justification":"As a second line (amlodipine does not seem to be sufficient here)."},{"idx":3,"correct":true,"proposition":"Thiazide","justification":""},{"idx":4,"correct":false,"proposition":"Beta-blocker","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-9-qi-12","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"What therapies are possible in this patient to reduce cardiovascular risk? (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Clopidogrel","justification":""},{"idx":1,"correct":false,"proposition":"Effective anticoagulation","justification":""},{"idx":2,"correct":true,"proposition":"Statine","justification":""},{"idx":3,"correct":false,"proposition":"Allopurinol","justification":""},{"idx":4,"correct":false,"proposition":"Fibrate","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-9-qi-13","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"You have prescribed an angiotensin 2-thiazide receptor antagonist combination. You see him again in nephrology consultation two months later with a control biological assessment. He tells you that he was bedridden for a few days due to sciatica and that he took ibuprofen in self-medication. His blood pressure is 122\/73 mmHg, his heart rate is 82\/min. The electrocardiogram is normal. The blood test is as follows: Na 140 mmol\/L, K 5.5 mmol\/L, HCO3 21 mmol\/L, urea 18 mmol\/L, creatinine 212 μmol\/L. What are the factors that may have favored this acute renal failure (one or more exact responses) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Taking nonsteroidal anti-inflammatory drugs","justification":""},{"idx":1,"correct":false,"proposition":"Intracellular dehydration","justification":""},{"idx":2,"correct":true,"proposition":"Stenosis of the renal arteries","justification":""},{"idx":3,"correct":true,"proposition":"Treatment with angiotensin 2 and thiazide receptor antagonist","justification":""},{"idx":4,"correct":false,"proposition":"Metformin therapy","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-9-qi-14","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"What is your therapeutic attitude? (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Stop ibuprofen","justification":""},{"idx":1,"correct":true,"proposition":"Suspend angiotensin receptor antagonist 2","justification":""},{"idx":2,"correct":true,"proposition":"Suspend thiazide","justification":""},{"idx":3,"correct":false,"proposition":"Infusion of calcium gluconate ampoule IVD","justification":""},{"idx":4,"correct":false,"proposition":"Replace metformin with a sulphonylurea","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-9-qi-15","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"Her kidney function has improved thanks to your treatment and her serum creatinine has stabilized at 140 μmol\/L. You want to formally rule out stenosis of the renal arteries. What imaging tests are appropriate for this patient at this stage? (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Renal Doppler ultrasound","justification":"Been there, done that 🤷 ♂️"},{"idx":1,"correct":true,"proposition":"Renal angiography","justification":""},{"idx":2,"correct":false,"proposition":"Kidney scan with captopril test","justification":""},{"idx":3,"correct":true,"proposition":"Renal MRI angiography","justification":""},{"idx":4,"correct":false,"proposition":"Renal arteriography","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-9-qi-16","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"You have performed the following radiological examination. What are the exact proposals? (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Arrow 1 corresponds to the small intestine","justification":"It is rather the colon (the colonist is the most peripheral, if there is nothing on the right 👉 it is the colon 💩!)."},{"idx":1,"correct":true,"proposition":"Arrow 2 corresponds to the superior mesenteric vein","justification":""},{"idx":2,"correct":false,"proposition":"Arrow 3 corresponds to the pylorus","justification":"This is the pancreas. We are too low for the stomach."},{"idx":3,"correct":true,"proposition":"Arrow 4 corresponds to the right renal artery","justification":""},{"idx":4,"correct":true,"proposition":"The examination is done at an arterial phase","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-9-qi-17","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"The examination performed does not find significant stenosis. What advice do you give to your patient following this episode? (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Hydration by Vichy water 2 liters \/ day","justification":""},{"idx":1,"correct":true,"proposition":"Drinks of at least 1 liter\/day and suitable for 24-hour diuresis","justification":""},{"idx":2,"correct":true,"proposition":"Suspend angiotensin II receptor antagonist and thiazide in dehydration","justification":""},{"idx":3,"correct":false,"proposition":"Hydration by low mineralized water 2 liters \/ day","justification":""},{"idx":4,"correct":true,"proposition":"Formal contraindication to nonsteroidal anti-inflammatory drugs","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-10-qi-1","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"During your first consultation, what element(s) could guide you towards secondary obesity? ","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"His waistline","justification":""},{"idx":1,"correct":false,"proposition":"An acanthosis nigricans","justification":"Acanthosis nigricans is an aspecific sign of insulin resistance."},{"idx":2,"correct":true,"proposition":"Colored stretch marks from the root of the limbs","justification":"The famous 'purple stretch marks'."},{"idx":3,"correct":true,"proposition":"Edema of the lower limbs","justification":"Extracellular hyperhydration is not classic."},{"idx":4,"correct":true,"proposition":"Bruising of the forearms","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-10-qi-2","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"Waist circumference is measured at 102 cm and hip circumference at 128 cm. There is no acanthosis nigricans. You notice some stretch marks that the patient reports as related to her weight changes. His blood pressure is measured at 140\/84 mmHg. You prescribe an initial biological assessment. What will it include in the first intention? (one or more correct answers) ","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Free thyroxine","justification":""},{"idx":1,"correct":true,"proposition":"Fasting blood glucose","justification":""},{"idx":2,"correct":true,"proposition":"Lipid profile","justification":""},{"idx":3,"correct":true,"proposition":"Uricemia","justification":"Uricemia is part of the list of the systematic bio assessment in front of adult obesity in the college 🤷 ♂️ (page 357 of the 2021 edition)."},{"idx":4,"correct":false,"proposition":"24-hour urinary free cortisol","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-10-qi-3","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"You see her again a month later, the weight is the same and the patient explains that she is very interested in bariatric surgery and wants more information. Which proposal(s) is (are) accurate?","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"he sleep apnea syndrome is a contraindication to performing bariatric surgery","justification":""},{"idx":1,"correct":true,"proposition":"bariatric surgery has no indication when the BMI is less than 35 kg\/m2","justification":""},{"idx":2,"correct":false,"proposition":"Gastric banding is the technique that has shown the most effective","justification":""},{"idx":3,"correct":true,"proposition":"bariatric surgery cannot be performed until summer","justification":""},{"idx":4,"correct":true,"proposition":"Gastric bypass is responsible for weight loss through both restriction and malabsorption"}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-10-qi-5","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"It presents the results of the prescribed biological assessment: \n\nnatremia 138 mmol\/L; \n\nserum potassium level 3.2 mmol\/L; \n\nfasting blood glucose 1.16 g\/L (6.38 mmol\/L); \n\ntotal cholesterol 1.83 g\/L (N: 1.8-2.4); \n\ntriglycerides 2.58 g\/L (N: 0.7-1.5); \n\nHDL-cholesterol 0.40 g\/L (N: 0.45-0.90); \n\nLDL-cholesterol 0.91 g\/L (N: 0.6-1.6); \n\nAST 38 IU\/L (N < 20); ALT 65 IU\/L (N< 40). \n\nYou suspect Cushing's syndrome. What arguments point to this hypothesis? (one or more correct answers) ","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Blood sugar","justification":"Hyperglycemia can quite fit into the nosological framework of a common obesity and does not particularly point to a Cushing's syndrome."},{"idx":1,"correct":true,"proposition":"Potassium levels","justification":""},{"idx":2,"correct":false,"proposition":"Blood triglyceride levels","justification":"Hypertriglyceridemia can quite fit into the nosological framework of a common obesity and does not particularly point to a Cushing's syndrome."},{"idx":3,"correct":false,"proposition":"LDL-cholesterol levels","justification":"LDL-cholesterol levels are normal here."},{"idx":4,"correct":false,"proposition":"The level of transaminases","justification":"Cytolysis can quite fit into the nosological framework of a common obesity and does not particularly point to a Cushing's syndrome."}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-10-qi-6","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"What biological tests can you order to support your diagnostic hypothesis? (one or more correct answers) ","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Plasma cortisol at 8 o'clock","justification":""},{"idx":1,"correct":false,"proposition":"Plasma ACTH at 8 o'clock","justification":""},{"idx":2,"correct":false,"proposition":"Dosage of ACTH at midnight","justification":""},{"idx":3,"correct":true,"proposition":"Salivary cortisol at midnight","justification":""},{"idx":4,"correct":true,"proposition":"Dexamethasone minute brake test","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-10-qi-7","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"She tells you that she had an abdominal CT scan a few weeks ago because of abdominal pain. Two sections are reproduced below. Arrows with numbers represent anatomical structures. What is the exact answer(s)? ","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"1 represents the right adrenal","justification":""},{"idx":1,"correct":false,"proposition":"2 represents the transverse colon","justification":"Stomach (we are too high to see the transverse colon, we do not see small intestine or right\/left colon)."},{"idx":2,"correct":true,"proposition":"3 represents the spleen","justification":""},{"idx":3,"correct":false,"proposition":"4 represents the inferior vena cava","justification":"This is the aorta. The VCI is very prominent."},{"idx":4,"correct":true,"proposition":"5 represents the body of the pancreas","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-10-qi-8","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"The abdominal CT scan she performed was normal. The report you gave him gives the following results: salivary cortisol at midnight at 4 times normal. You have confirmed hypercortisolism by a 24-hour urine free cortisol assay with a result of 245 μg\/24 hours (N < 60). ACTH was dosed at 85 pg\/mL (N: 10-50). Which exam(s) can you now prescribe? ","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A metopirone test","justification":""},{"idx":1,"correct":true,"proposition":"A test at the CRH","justification":"The increase in cortisol after a CRH injection may confirm the pituitary origin of the hypersecretion (versus a paraneoplastic origin)."},{"idx":2,"correct":false,"proposition":"A dosage of delta 4 androstenedione","justification":""},{"idx":3,"correct":true,"proposition":"Pituitary MRI","justification":""},{"idx":4,"correct":false,"proposition":"Insulin hypoglycemia","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-10-qi-9","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"The CRH test shows a marked elevation of ACTH and cortisol. A section of the pituitary MRI you prescribed is reproduced below. Arrows with letters represent anatomical structures. Which structure(s) is correctly identified?","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A represents the third ventricle","justification":""},{"idx":1,"correct":true,"proposition":"B represents the optical chiasm","justification":""},{"idx":2,"correct":true,"proposition":"C represents pituitary adenoma","justification":""},{"idx":3,"correct":false,"proposition":"D represents the cavernous sinus","justification":""},{"idx":4,"correct":true,"proposition":"E represents the left internal carotid artery","justification":"She makes a little bow of families (that's why we see her twice 🥐)"}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-10-qi-10","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"In front of this pituitary macroadenoma, you want to complete your biological assessment. Which of the following proposals do you think is relevant to prescribe in this context? ","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"T4 assay","justification":"TSH + T4 assay"},{"idx":1,"correct":false,"proposition":"DHA Testing","justification":"DHA is secreted by the post-pituitary gland."},{"idx":2,"correct":false,"proposition":"GnRH testing","justification":""},{"idx":3,"correct":false,"proposition":"Dosage de la POMC","justification":"Almost never doses."},{"idx":4,"correct":true,"proposition":"Prolactin Determination","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-10-qi-11","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"The complementary balance shows: TSH 1.1 mIU\/L (N: 0.4-4); T4 14.8 pmol\/L (N: 8-20); estradiol 10 pg\/ml (N: 40-150); FSH 0, 1 IU\/L (N: 2-6); LH 0.5 IU\/L (N: 2-8); prolactin 30 μg\/L (N 25). What elements do you mention about this assessment? (one or more correct answers)","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Central hypothyroidism","justification":""},{"idx":1,"correct":true,"proposition":"Disconnection hyperprolactinemia","justification":"We speak of disconnection because < 100 μg\/L. Beyond that, we can talk about a prolactinoma."},{"idx":2,"correct":true,"proposition":"Hypogonadotropic hypogonadism","justification":""},{"idx":3,"correct":true,"proposition":"Pituitary anterior insufficiency","justification":"To check each time you have a deficiency of a lineage, it is an anterior pituitary insufficiency. Not to be confused with panhypopituitarism."},{"idx":4,"correct":false,"proposition":"Somatotropic deficiency","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-10-qi-12","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"To assess the impact of this Cushing's syndrome, you prescribe a bone densitometry, the results of which are reproduced below.\nWhich of the following is correct?","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"There is trabecular osteoporosis","justification":""},{"idx":1,"correct":true,"proposition":"The risk of spinal fracture (RA) is 73%","justification":""},{"idx":2,"correct":true,"proposition":"The disorders observed may be increased by estrogenic deficiency","justification":""},{"idx":3,"correct":true,"proposition":"The observed disorders may be increased by hyperprolactinemia","justification":""},{"idx":4,"correct":false,"proposition":"The observed disorders may be increased by obesity","justification":"Obesity does not lead to osteoporosis. It is even sometimes considered a protective factor: more fatty 👉 tissue more protection of the bone in case of trauma."}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-10-qi-13","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"You retain the diagnosis of corticotropic macro-adenoma and entrust the patient to your neurosurgeon colleague who practices his public activity at the CHU. He performed a rhinoseptal resection of this adenoma a few days later. There is no intraoperative incident and the neurosurgeon considers its excision satisfactory. In the recovery room, the patient quickly desaturates and presents a state of shock. Resuscitation measures are started immediately. However, the patient died a few minutes later. In this context, the neurosurgeon would like to perform a scientific autopsy to know the exact causes of death. What is (are) the procedure(s) to be carried out before this autopsy can be carried out ","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Querying the automated national register of refusals","justification":""},{"idx":1,"correct":false,"proposition":"Judicial report to the public prosecutor","justification":""},{"idx":2,"correct":true,"proposition":"Obtaining the approval of a pathologist to perform the autopsy","justification":""},{"idx":3,"correct":false,"proposition":"Search for an organ donor card in the patient","justification":""},{"idx":4,"correct":true,"proposition":"Interview with the family to seek the non-opposition of the patient during her lifetime","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-10-qi-14","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"The patient's family wishes to obtain a medical certificate. For what reason(s) can the doctor write it?","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"To find out the cause of death","justification":""},{"idx":1,"correct":true,"proposition":"To defend the memory of the deceased","justification":""},{"idx":2,"correct":false,"proposition":"To provide a comprehensive list of the patient's history","justification":""},{"idx":3,"correct":false,"proposition":"To rule out a suicide"},{"idx":4,"correct":true,"proposition":"To assert the rights of the family","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-10-qi-15","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"The scientific autopsy performed reveals a massive proximal pulmonary embolism of both branches of the pulmonary artery. The family decides to initiate proceedings. What type(s) of responsibility can be engaged then?","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Criminal liability of the physician","justification":""},{"idx":1,"correct":false,"proposition":"No-fault liability of the physician","justification":"The patient died."},{"idx":2,"correct":true,"proposition":"Physician's civil liability","justification":"It will be engaged in case of detachable fault of the establishment."},{"idx":3,"correct":true,"proposition":"Administrative responsibility of the institution","justification":""},{"idx":4,"correct":true,"proposition":"Disciplinary responsibility of the physician","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-11-qi-1","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"Which diagnosis do you mention as a priority?","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Infantile hemangioma"},{"idx":1,"correct":false,"proposition":"Planar angioma"},{"idx":2,"correct":false,"proposition":"Syndrome de Kasabach-Merritt","justification":""},{"idx":3,"correct":false,"proposition":"Venous angioma"},{"idx":4,"correct":false,"proposition":"Lymphangioma"}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-11-qi-2","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"You suspect an infantile hemangioma. What is (are) the semiological element(s) that you will find at Romain's clinical examination? ","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A blowing character to auscultation","justification":""},{"idx":1,"correct":false,"proposition":"A shudder on palpation","justification":""},{"idx":2,"correct":true,"proposition":"An elastic consistency on palpation","justification":""},{"idx":3,"correct":false,"proposition":"A flat character on palpation","justification":""},{"idx":4,"correct":false,"proposition":"Hypertrophy of the hemiface on inspection","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-11-qi-3","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"Romain's parents ask you about the evolution and possible complications to expect from this infantile hemangioma. What do you say to them? (one or more correct answers) ","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A histological examination of the lesion makes it possible to better specify the chances of spontaneous involution","justification":""},{"idx":1,"correct":true,"proposition":"A growth phase may occur during the next few months","justification":""},{"idx":2,"correct":true,"proposition":"There is a risk of amblyopia","justification":"Given the location of this hemangioma, there is a risk that it covers the eye of little Theo and that this leads to functional 😥 amblyopia."},{"idx":3,"correct":true,"proposition":"The lesion may ulcerate","justification":""},{"idx":4,"correct":true,"proposition":"Complete disappearance without sequelae occurs in 50% of cases","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-11-qi-4","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"Parents are concerned about the risk of growth of the lesion and the risk of functional amblyopia by occlusion of the cleft palpebral, and ask if treatment will then be offered for Romain. What do you say to them? (one or more correct answers) ","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Treatment with propranolol will be offered","justification":""},{"idx":1,"correct":false,"proposition":"Pulsed dye laser treatment will be offered","justification":""},{"idx":2,"correct":false,"proposition":"Embolization treatment in interventional radiology will be proposed","justification":""},{"idx":3,"correct":false,"proposition":"Surgical treatment will be offered","justification":""},{"idx":4,"correct":false,"proposition":"Low molecular weight heparin therapy will be proposed","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-11-qi-5","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"Following a phase of growth of the lesion and the risk of impact on the palpebral opening, treatment with propranolol was put in place, allowing the complete disappearance of the lesion, without sequelae. You see Romain again in consultation at the age of 18 months because he has for several weeks an itchy skin involvement predominant on the face, and his sleep is disturbed. It is apyretic with conservation of the general condition. What semiological element(s) do you identify on this image?","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Xerosis","justification":"Hard to see in this photo."},{"idx":1,"correct":true,"proposition":"Erythema","justification":""},{"idx":2,"correct":false,"proposition":"Excoriations","justification":"Hard to see in this photo."},{"idx":3,"correct":false,"proposition":"Exanthema","justification":""},{"idx":4,"correct":false,"proposition":"Enanthemum","justification":"No mucous membrane is seen."}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-11-qi-6","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"Which of the following interrogation elements is relevant, if present, to support the diagnosis you suspect in Romain? ","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"History of asthma in Romain's father","justification":""},{"idx":1,"correct":false,"proposition":"History of psoriasis in Romain's mother","justification":"Psoriasis is not affected by atopic risk."},{"idx":2,"correct":true,"proposition":"Cow's milk protein allergy in Romain's brother","justification":""},{"idx":3,"correct":false,"proposition":"Recent pruritus in several family members","justification":"We are not looking for scabies but rather eczema (= atopic dermatitis) 😅"},{"idx":4,"correct":false,"proposition":"Frequent herpetic recurrences in Romain's mother","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-11-qi-7","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"You are diagnosed with atopic dermatitis motivating local corticosteroid therapy. What attitude(s) of prevention and prophylaxis do you put in place? ","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Adapt the vaccination schedule according to the evolution of the pathology","justification":""},{"idx":1,"correct":false,"proposition":"Prophylaxis of herpes superinfections with aciclovir","justification":""},{"idx":2,"correct":false,"proposition":"Prevention of superinfection by regular use of antiseptics","justification":""},{"idx":3,"correct":true,"proposition":"Daily use of fragrance-free emollients on body and face","justification":""},{"idx":4,"correct":true,"proposition":"Maintain a cool temperature in the room","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-11-qi-8","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"You see again urgently Romain 1 month later for a predominant rash on the trunk, appeared the night before, in a context of fever up to 39 ° C for 2 days, without alteration of the general condition. The temperature measured in the office is 37.2 ° C (last taken of paracetamol 24 hours ago). The clinical examination, apart from the skin examination, is unremarkable. What diagnosis(s) do you mention?","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Food allergies"},{"idx":1,"correct":false,"proposition":"Syndrome de Kaposi-Juliusberg","justification":""},{"idx":2,"correct":false,"proposition":"Measles"},{"idx":3,"correct":true,"proposition":"Infantile roseola"},{"idx":4,"correct":false,"proposition":"Epidemic megalerythema"}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-11-qi-9","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"You mention an infantile roseola (or sudden exanthema of the infant). What is the causative infectious agent? ","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Epstein-Barr virus"},{"idx":1,"correct":false,"proposition":"HSV-1 (herpes simplex virus)","justification":""},{"idx":2,"correct":false,"proposition":"Group A streptococcus"},{"idx":3,"correct":true,"proposition":"HHV-6 (herpes virus type 6)"},{"idx":4,"correct":false,"proposition":"Parvovirus B19"}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-11-qi-10","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"What recommendation(s) and\/or prescription(s) do you make to parents regarding the management of Romain roseola? ","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Eviction from the nursery for 10 days","justification":""},{"idx":1,"correct":false,"proposition":"Realization of a urine strip for proteinuria in 3 weeks","justification":""},{"idx":2,"correct":false,"proposition":"Prescription of ibuprofen","justification":""},{"idx":3,"correct":true,"proposition":"Prescription of paracetamol 15 mg\/kg every 4 to 6 hours, if fever rises","justification":""},{"idx":4,"correct":false,"proposition":"Prescription of a 17-butyrate hydrocortisone cream with 1 application per day on the body for 5 days","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-11-qi-11","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"After this intercurrent infectious episode, atopic dermatitis experienced a spontaneously favorable evolution. Now 5 years old and enrolled in kindergarten, he is brought to you by his parents for skin and hair lesions evolving for a few weeks. What diagnosis(s) do you evoke in front of these facial and scalp lesions? ","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Psoriasis"},{"idx":1,"correct":false,"proposition":"Seborrheic dermatitis"},{"idx":2,"correct":true,"proposition":"Dermatophyte infection"},{"idx":3,"correct":false,"proposition":"Trichotillomania"},{"idx":4,"correct":false,"proposition":"Plate pelade"}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-11-qi-12","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"Examination with Wood's lamp shows yellow-green fluorescence of the hairs in favor of microsporic ringworm. What do you do while waiting for the result of cultivation? (only one answer expected) ","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Therapeutic abstention","justification":""},{"idx":1,"correct":true,"proposition":"Prescription of local antifungals only","justification":"To be introduced after sampling to maximize their profitability."},{"idx":2,"correct":false,"proposition":"Prescription of systemic antifungals only","justification":""},{"idx":3,"correct":false,"proposition":"Prescription of local and systemic antifungals","justification":""},{"idx":4,"correct":false,"proposition":"Prescription of an antiseptic only","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-11-qi-13","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"In front of this microsporic ringworm with a very extensive alopecic plaque associated with several lesions of dermatophytosis of the hairless skin, you begin, without waiting for the results of the culture, a treatment combining local and systemic antifungals. Which systemic antifungal will you prescribe, as a first intention, to Romain? ","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Ketoconazole","justification":""},{"idx":1,"correct":false,"proposition":"ltraconazole","justification":""},{"idx":2,"correct":true,"proposition":"Griseofulvin","justification":"Treatment of moths of choice in children."},{"idx":3,"correct":false,"proposition":"Amphotericin B","justification":""},{"idx":4,"correct":false,"proposition":"Caspofungin","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-11-qi-14","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"The result of the culture comes back positive 3 weeks later to Microsporum canis. How could Romain be contaminated? ","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"By a dog","justification":""},{"idx":1,"correct":true,"proposition":"By a cat","justification":""},{"idx":2,"correct":false,"proposition":"By a land turtle","justification":""},{"idx":3,"correct":false,"proposition":"By a classmate","justification":""},{"idx":4,"correct":false,"proposition":"By the ground","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-12-qi-1","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"The doctor evokes the hypothesis of domestic violence. Which element(s) of the statement is (are) in favor of this hypothesis? ","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The presence of bruises of different ages","justification":""},{"idx":1,"correct":true,"proposition":"An incompatibility between a fall from stairs and the lesions observed","justification":""},{"idx":2,"correct":true,"proposition":"Emergency room admission time","justification":""},{"idx":3,"correct":false,"proposition":"The age of the patient","justification":""},{"idx":4,"correct":true,"proposition":"Sleep disorders","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-12-qi-2","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"Ms. X confirms that she was physically abused by her spouse the day before. She states that he took her by the neck, that she tried to protect herself by putting his hand in front of her face, but took several punches to the left hemiface. During this episode there was forced sex. Mrs. X came tonight because she was home alone, but does not plan to file a complaint because she does not want marital separation. The doctor considers whether to notify the public prosecutor. What criteria in the statement support compliance with the patient's choice not to file a complaint? (one or more correct answers) ","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The age of the patient","justification":""},{"idx":1,"correct":true,"proposition":"The absence of cognitive impairment","justification":""},{"idx":2,"correct":false,"proposition":"The presence of bruises of different ages","justification":""},{"idx":3,"correct":true,"proposition":"The absence of imminent danger at home","justification":""},{"idx":4,"correct":false,"proposition":"The occurrence of sexual violence associated with physical violence","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-12-qi-3","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"As Mrs. X is of age, without physical or psychological vulnerability, and not wishing to file a complaint, the doctor decided to respect her request and not to make a judicial report. What paraclinical element(s) can (s) be part of the management of this patient in the emergency room?","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Taking photographic photographs to document traumatic bodily injuries","justification":""},{"idx":1,"correct":false,"proposition":"Whole-body X-rays looking for fractures of different ages","justification":""},{"idx":2,"correct":false,"proposition":"A brain scan","justification":"Traumatic brain injury without loss of consciousness, without headache, without Master > 1 criteria."},{"idx":3,"correct":false,"proposition":"A fundus","justification":""},{"idx":4,"correct":false,"proposition":"A CPK blood test for muscle bruises","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-12-qi-4","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"Here is the picture of the arm of the outer face of the left arm. Which proposal(s) is true?","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"This lesion may correspond to the imprint of the pulp of a finger on the arm.","justification":""},{"idx":1,"correct":false,"proposition":"This lesion is recent in appearance","justification":""},{"idx":2,"correct":true,"proposition":"This lesion is older than those found in the left hemiface"},{"idx":3,"correct":false,"proposition":"This lesion may correspond to friction of the arm against a hard plane","justification":""},{"idx":4,"correct":true,"proposition":"This injury may correspond to a direct blow with an object on the arm.","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-12-qi-5","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"The doctor proposes to make a descriptive medical certificate. What should be mentioned? (one or more correct answers)","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The alleged date of the last episode of violence suffered by Ms X","justification":"In quotation marks"},{"idx":1,"correct":true,"proposition":"The objective account of the violence suffered by Mrs. X","justification":"In quotation marks"},{"idx":2,"correct":true,"proposition":"Description of all visible traumatic injuries","justification":""},{"idx":3,"correct":false,"proposition":"Ms. X's gynaecological history","justification":"This is irrelevant."},{"idx":4,"correct":true,"proposition":"The psychological symptoms resulting from the violence suffered by Ms X","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-12-qi-6","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"The psychological repercussions resulting from the violence must be investigated and mentioned on the descriptive medical certificate. What symptoms should the doctor look for when questioning Mrs. X to assess these repercussions and manage them? (one or more correct answers)","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Generalized anxiety"},{"idx":1,"correct":true,"proposition":"Nightmares"},{"idx":2,"correct":false,"proposition":"A quirk of contact"},{"idx":3,"correct":false,"proposition":"Auditory hallucinations","justification":""},{"idx":4,"correct":true,"proposition":"Avoidance pipes"}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-12-qi-7","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"During the interrogation, Mrs. X explains that she has been disturbed for several months in a disturbed sleep, with bad dreams where she sees herself pursued by a threatening shadow. She wakes up early, little rested, but cannot sleep during the day, always awake, jumping at the slightest noise. She gets angry more easily with her children. During the day, when she goes shopping, she makes detours to avoid passing in front of her husband's work and gym, to be sure not to cross him. Eventually, she ends up falling asleep, exhausted, in front of the television at night.\nMrs. X puts all this down to tensions in her work, and a recent family bereavement.\nShe explains that apart from a few episodes of slapping and forced sex, she has never been a victim of violence by her husband. When she hears about domestic violence, she doesn't feel concerned.\nAmong the elements of the interrogation, what symptoms are suggestive of post-traumatic stress disorder? (one or more correct answers)","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Sleep disorders"},{"idx":1,"correct":true,"proposition":"Avoidance lines"},{"idx":2,"correct":true,"proposition":"Denial of violence"},{"idx":3,"correct":true,"proposition":"Irritability"},{"idx":4,"correct":true,"proposition":"Hypervigilance"}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-12-qi-8","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"After a full information provided by the doctor, Mrs. X agrees to file a complaint. The doctor calls the judicial police officer on duty at the police station, who goes to the hospital to receive Ms. X's complaint. A gynaecological examination as well as medico-legal samples are requested on judicial requisition. These samples: ","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Are analyzed urgently at the hospital laboratory at the request of the medical examiner","justification":""},{"idx":1,"correct":true,"proposition":"Aim to highlight the DNA of the perpetrator","justification":""},{"idx":2,"correct":true,"proposition":"Must be duplicated","justification":""},{"idx":3,"correct":true,"proposition":"Are placed under seal by the judicial police officer","justification":""},{"idx":4,"correct":true,"proposition":"Are elements of the judicial procedure","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-12-qi-9","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"In the requisition, the judicial police officer asks you to set the ITT resulting from the violence. What does this acronym mean? ","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Total temporary incapacity","justification":"To avoid melting, we now speak of Total Functional Deficit (FTD)."},{"idx":1,"correct":true,"proposition":"Total incapacity for work","justification":""},{"idx":2,"correct":false,"proposition":"Temporary impossibility of work","justification":""},{"idx":3,"correct":false,"proposition":"Inability to work fully","justification":""},{"idx":4,"correct":false,"proposition":"Total impossibility of work","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-12-qi-10","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"What will be the purpose of the ITT (total incapacity for work) assessment for a victim of violence? (one or more correct answers) ","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"To classify the criminal offence of which she was a victim","justification":""},{"idx":1,"correct":false,"proposition":"Obtain emergency social housing more quickly if they leave home","justification":""},{"idx":2,"correct":false,"proposition":"To determine the duration of the prescribed absence from work following his injuries","justification":""},{"idx":3,"correct":true,"proposition":"To enable the magistrate to know the repercussions of the violence suffered on the state of health","justification":""},{"idx":4,"correct":true,"proposition":"To determine the competent court to try the perpetrator of the violence","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-12-qi-11","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"In the case of Ms. X, solicitor-client privilege: (one or more correct answers) ","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Is, unless otherwise specified, an obligation of the health professional","justification":""},{"idx":1,"correct":false,"proposition":"Allows the transmission of medical information about her to a police officer by telephone","justification":""},{"idx":2,"correct":false,"proposition":"Allows the transmission of medical information concerning her to her spouse","justification":""},{"idx":3,"correct":true,"proposition":"Persists in case of judicial requisition for all medical information that does not concern the questions of requisition","justification":""},{"idx":4,"correct":true,"proposition":"Allows the patient to be personally transmitted of the descriptive medical certificate upon discharge from the hospital if she does not wish to file a complaint","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-12-qi-12","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"Three weeks after Ms. X went to the emergency room, her husband, from whom she had separated, sent a letter to the hospital to complain about the medical certificate drawn up on requisition, which had been sent to her by her lawyer. He explains that the doctor did not put the story of the violence in the conditional and that he considers himself wrongly accused. In this context, what medical liability(s) can (s) be engaged? ","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Disciplinary responsibility","justification":""},{"idx":1,"correct":true,"proposition":"Civil liability","justification":"If the fault is detachable from the service."},{"idx":2,"correct":true,"proposition":"Criminal liability","justification":""},{"idx":3,"correct":true,"proposition":"Administrative responsibility","justification":""},{"idx":4,"correct":false,"proposition":"No-fault liability","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-12-qi-13","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"Eleven weeks later, Ms. X returned to the hospital because she knew she was pregnant as a result of the sexual violence she had reported during admission. She wishes to benefit from a voluntary termination of pregnancy. What is the real proposal(s)? ","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"The doctor is obliged to inform the police of this pregnancy","justification":""},{"idx":1,"correct":false,"proposition":"A voluntary medical termination of pregnancy may be proposed to Mrs. X","justification":""},{"idx":2,"correct":true,"proposition":"Two consultations are offered before the voluntary termination of pregnancy","justification":""},{"idx":3,"correct":false,"proposition":"The consent of Mrs X's spouse is required for the initiation of the procedure","justification":""},{"idx":4,"correct":false,"proposition":"The agreement of the public prosecutor is necessary for the initiation of the procedure","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-14-qi-1","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"What is (are) the criterion(s) of severity in this febrile child? ","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"His plainty cry","justification":""},{"idx":1,"correct":false,"proposition":"Age","justification":"The severity criteria for acute bronchiolitis in infants are: FR > 60\/min, HR > 180\/min, pauses in breathing, signs of struggle, SpO2 < 92%, anorexia."},{"idx":2,"correct":true,"proposition":"His heart rate","justification":""},{"idx":3,"correct":true,"proposition":"His breathing rate","justification":""},{"idx":4,"correct":false,"proposition":"Its skin recoloration time","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-14-qi-2","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"Given this clinical picture, what action do you take immediately? (only one answer expected)","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"NaCl bolus 0.9% 20 mL\/kg","justification":""},{"idx":1,"correct":false,"proposition":"Microbiological","justification":""},{"idx":2,"correct":false,"proposition":"Capillary blood glucose","justification":""},{"idx":3,"correct":false,"proposition":"Blood lonogram","justification":""},{"idx":4,"correct":false,"proposition":"Paracetamol 15 mg\/kg","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-14-qi-3","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"You have done vascular filling with 0.9% NaCl. Fifteen minutes later, his constants are as follows: heart rate 150 beats per minute, respiratory rate 70 per minute, temperature 39.1 ° C, skin recoloration time at 1 second. Chest auscultation regains a symmetrical vesicular murmur and a systolic murmur at 2\/6. Abdominal palpation is normal and otoscopy shows a hypervascularized right eardrum. The child is reactive, without hypotonia. \nWhat is the most likely diagnosis? ","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Purulent acute otitis media","justification":""},{"idx":1,"correct":false,"proposition":"Acute bronchiolitis","justification":""},{"idx":2,"correct":true,"proposition":"Acute pneumonia","justification":"High fever and lack of sibilants point more towards pneumonia."},{"idx":3,"correct":false,"proposition":"Infective endocarditis","justification":""},{"idx":4,"correct":false,"proposition":"Purulent meningitis","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-14-qi-4","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"You mention pneumococcal pneumonia. Which of the following is(s) in favor of this diagnosis?","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"The presence of nasopharyngitis","justification":""},{"idx":1,"correct":false,"proposition":"Age","justification":""},{"idx":2,"correct":true,"proposition":"The brutal beginning","justification":""},{"idx":3,"correct":false,"proposition":"A family storytelling","justification":""},{"idx":4,"correct":true,"proposition":"Poor food intake","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-14-qi-5","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"Chest X-ray shows systematized opacity of the right upper lobe with an aerial bronchogram. What is your assessment? ","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Blood ionogram","justification":""},{"idx":1,"correct":false,"proposition":"Legionella antigen in urine","justification":""},{"idx":2,"correct":true,"proposition":"Blood","justification":""},{"idx":3,"correct":false,"proposition":"Pneumococcal PCR on nasopharyngeal secretions","justification":""},{"idx":4,"correct":false,"proposition":"Hepatic test","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-14-qi-6","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"The blood test shows the following results: \n\nhemoglobin 115 g\/L, \n\nleukocytes 20 G\/L with 75% neutrophils, \n\nplatelets 400 G\/L, \n\nCRP 250 mg\/l, \n\nnatremia 129 mmol\/l, potassium 3.7 mmol\/l, \n\nurea 1.5 mmol\/l, creatinine 30 micromoles\/l. \n\nWhat pathophysiological elements are likely involved in this hyponatremia? (one or more correct answers)","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"A secretion of antidiuretic hormone","justification":""},{"idx":1,"correct":false,"proposition":"Adrenal insufficiency","justification":""},{"idx":2,"correct":true,"proposition":"Extracellular dehydration","justification":""},{"idx":3,"correct":false,"proposition":"An unsuitable infusion","justification":""},{"idx":4,"correct":false,"proposition":"Postpneumoccoccal glomerulonephritis","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-14-qi-7","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"You mention acute hyponatremia in a context of possible extracellular dehydration and DHA secretion complicating acute pneumonia. You set up an infusion adapted to ionic disorders. Which of the following offers do you offer antibiotic therapy?","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Intravenous amoxicillin","justification":""},{"idx":1,"correct":false,"proposition":"Dual therapy amoxicillin and macrolide","justification":""},{"idx":2,"correct":false,"proposition":"Oral amoxicillin","justification":""},{"idx":3,"correct":false,"proposition":"Intravenous cefotaxima","justification":""},{"idx":4,"correct":false,"proposition":"Macrolide per os","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-14-qi-8","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"You have started treatment with amoxicillin 90 mg\/kg\/day intravenously. 72 hours later, the infant remains feverish at 39.5°C.  You make an X-ray of the chest, interpret the images you see. ","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Shot made in the supine position","justification":""},{"idx":1,"correct":false,"proposition":"Strictly frontal impact","justification":""},{"idx":2,"correct":true,"proposition":"Presence of right fluid pleural effusion","justification":"We do not see a Damoiseau line because the child is lying, so the fluid is behind the pulmonary parenchyma and corresponds to the opacity of the lung."},{"idx":3,"correct":true,"proposition":"Presence of a right perihilar opacity","justification":""},{"idx":4,"correct":false,"proposition":"Abnormal enlargement of the upper mediastinum","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-14-qi-9","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"You carry the diagnosis of purulent pleurisy and adapt your antibiotic therapy. Which germ(s) should or should be covered by this antibiotic therapy?  ","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Staphylococcus aureus","justification":"Staphylococcus aureus infection is a common cause of purulent pleurisy."},{"idx":1,"correct":true,"proposition":"Streptococcus pneumoniae","justification":""},{"idx":2,"correct":true,"proposition":"Streptococcus pyogenes","justification":""},{"idx":3,"correct":false,"proposition":"Mycoplasma pneumoniae","justification":""},{"idx":4,"correct":false,"proposition":"Non-typeable Haemophilus","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-14-qi-10","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"The evolution is favorable under antibiotic therapy and the child is released from hospitalization 7 days later. He returned to the emergency room at 9 months of age for cough with fever at 38.2°C and difficulty breathing. The parents report that he presented with a febrile cough at the age of 7 months treated with oral antibiotic therapy. Weight gain between 6 and 9 months was 750 g. \n\nAt auscultation, you hear bilateral sibillants. You perform a chest X-ray that shows a systematized focus of the lower left lobe with aerial bronchogram. Faced with this recurrence, what is (are) the cause(s) to evoke? ","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Infant asthma","justification":"Infant asthma has a new definition: three episodes of wheezing dyspnea before 12 months, or two episodes + atopy (personal or family) before 12 months."},{"idx":1,"correct":true,"proposition":"Immunodeficiency","justification":""},{"idx":2,"correct":false,"proposition":"Intrabronchial foreign body","justification":""},{"idx":3,"correct":false,"proposition":"Congenital lung malformation","justification":""},{"idx":4,"correct":true,"proposition":"Cystic fibrosis","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-14-qi-11","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"What additional examination(s) do you do on this child? ","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Pulmonary function tests","justification":"He is a little young to blow into a tube 😇. EFRs, in fact, are not feasible for 3 to 6 years."},{"idx":1,"correct":true,"proposition":"Chest CT scan","justification":""},{"idx":2,"correct":false,"proposition":"Bronchial endoscopy","justification":""},{"idx":3,"correct":true,"proposition":"Immune investigation","justification":""},{"idx":4,"correct":false,"proposition":"PH-metry","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-14-qi-12","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"For the exploration of an immune deficiency, what is your first-line assessment?","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Weight determination of immunoglobulins","justification":""},{"idx":1,"correct":false,"proposition":"Lymphocyte phenotyping","justification":"Lymphocyte phenotyping detects membrane antigens (CD4, CD8, CD19, CD20, etc.) of lymphocytes to know if they are B, T, NK lymphocytes or other. It is, in this situation, a second-line examination."},{"idx":2,"correct":true,"proposition":"Post-vaccination serology"},{"idx":3,"correct":false,"proposition":"Exploring complement pathways","justification":""},{"idx":4,"correct":false,"proposition":"Determination of lgE"}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-14-qi-13","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"To explore the possibility of immune deficiency, the assessment includes a weight assay of immunoglobulins and post-vaccination serologies. The complete blood count was normal. Here are the results available at this stage: IgG 1 g\/L (N 3.3-6.2), lgA 0.2 g\/L (N 0.2-0.8), lgM 0.7 g\/L (0.5-1.3). Post-vaccination serologies reveal a defect in the production of specific antibodies. Which diagnosis do you think is most likely? (only one answer expected) ","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Common variable immunodeficiency","justification":""},{"idx":1,"correct":false,"proposition":"Combined immunodeficiency","justification":""},{"idx":2,"correct":false,"proposition":"Severe combined immunodeficiency","justification":""},{"idx":3,"correct":false,"proposition":"CD40 ligand deficiency","justification":""},{"idx":4,"correct":false,"proposition":"Absence of immune deficiency","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-14-qi-14","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"You confirm the diagnosis of variable common immunodeficiency. As the vaccination schedule was respected until the age of 9 months, which vaccine(s) are indicated for this child for the next 6 months? ","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Measles-mumps-rubella","justification":"This vaccine is a live attenuated vaccine. It is contraindicated in case of immunosuppression."},{"idx":1,"correct":true,"proposition":"Polysaccharide pneumococcal","justification":""},{"idx":2,"correct":true,"proposition":"Meningococcal C","justification":""},{"idx":3,"correct":false,"proposition":"Chickenpox","justification":""},{"idx":4,"correct":true,"proposition":"Hepatitis B","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-15-qi-1","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"Which of the following proposals concerning the etiology of malaise would you provide discriminating information?","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The slow return to consciousness","justification":""},{"idx":1,"correct":false,"proposition":"Urine loss","justification":"Urine loss is not to be considered as a distinguishing element between the cardiac or epileptic origin of the malaise."},{"idx":2,"correct":false,"proposition":"Abdominal pain","justification":""},{"idx":3,"correct":false,"proposition":"The localization of hematomas of the limbs","justification":""},{"idx":3,"correct":true,"proposition":"The bite of the lateral edge of the tongue","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-15-qi-2","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"The dislocation is managed orthopedically. You hospitalize him for monitoring and assessment of the malaise. \n\nThe first night of hospitalization is difficult with constant wandering. The next morning, the staff noticed agitation and she tore off her drip. She does not see the point and wants to leave the institution. You notice a tremor of the upper limbs when maintaining the attitude. Objective examination (difficult given the patient's weak cooperation) seems normal except for an abolition of Achilles reflexes. The interrogation is difficult. Spontaneously, his speech is disjointed and incoherent. Which of the following suggestions regarding your diagnostic orientation on its current condition is compatible with this table?","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Pre delirium tremens","justification":""},{"idx":1,"correct":false,"proposition":"Status epilepticus","justification":""},{"idx":2,"correct":false,"proposition":"Parkinson's syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Amnesic ictus","justification":""},{"idx":3,"correct":true,"proposition":"Mental confusion","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-15-qi-3","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"What additional biological examination(s) are you performing at this stage to advance on the etiological context of this patient? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Complete blood count","justification":""},{"idx":1,"correct":true,"proposition":"Transaminases","justification":"An increase in OGT\/AST greater than that of TGP\/ALT may indicate chronic alcohol poisoning."},{"idx":2,"correct":true,"proposition":"Glycemia","justification":""},{"idx":3,"correct":true,"proposition":"Natremiah","justification":""},{"idx":4,"correct":false,"proposition":"Sedimentation rate","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-15-qi-4","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"The patient remains agitated and not very compliant. At this stage, biological results show MCV at 114μm (N < 100), TGO (aspartame aminotransferase) at 155 (N < 40), TGP (alanine aminotransferase) at 63 (N < 40), zero ethylemia and natremia at 134 mmol \/ L. What non-biological examination should be performed at this stage and during the day (only one response expected):","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Brain scan","justification":""},{"idx":1,"correct":false,"proposition":"Doppler echo of supra-aortic trunks","justification":""},{"idx":2,"correct":false,"proposition":"Electroencephalogram","justification":""},{"idx":3,"correct":false,"proposition":"Electroneuromyogram","justification":""},{"idx":4,"correct":false,"proposition":"Abdominal ultrasound","justification":"Abdominal ultrasound could give arguments for cirrhosis (bumpy liver, increased hepatic arrow, hyperechogenicity of the parenchyma, signs of portal hypertension) but, in front of the neurological signs and the context of fall (and potential head trauma), brain scan is more priority."}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-15-qi-5","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"The brain scan reveals diffuse and age-significant atrophy. An electroencephalogram is performed but is artefacted by the patient's movements and does not allow reliable interpretation. Which of the following therapeutic proposals are you putting in place at this stage? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Hydration based on glucose serum","justification":"Glucose increases the use of vitamin B1 and therefore the risk of Gayet-Wernicke encephalopathy. The patient must be hydrated with 0.9% NaCl."},{"idx":1,"correct":false,"proposition":"Anti-staphylococcal antibiotic therapy","justification":""},{"idx":2,"correct":false,"proposition":"Parenteral neuroleptic","justification":""},{"idx":3,"correct":true,"proposition":"Vitamin supplementation","justification":""},{"idx":4,"correct":true,"proposition":"Parenteral benzodiazepine","justification":"The patient appears to have symptoms of alcohol withdrawal, which therefore requires an emergency pharmacological prerisk. The patient's lack of compliance and the need for rehydration (so the patient will have a venous line in all cases) directs us towards a parenteral route."}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-15-qi-6","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"Concomitantly with the placement of the venous line, she presents a loss of consciousness with a period of generalized hypertonia and movements of the 4 limbs. She is receiving an intravenous benzodiazepine. The awakening is gradual. \n\nIn the hours that followed, confusion and agitation increased; The patient is covered in sweat, she makes incoherent remarks. Blood pressure is at 180\/110 mmHg. The heart rate is at 110\/min. The temperature is 38.5 °C.  The clinical examination is difficult but finds no obvious signs of neurological focus. \n\nWhich of the following diagnostic proposals is (are) accurate? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Acute delirious puff","justification":""},{"idx":1,"correct":false,"proposition":"Idiopathic generalized epilepsy","justification":""},{"idx":2,"correct":false,"proposition":"Toxic encephalopathy","justification":""},{"idx":3,"correct":true,"proposition":"Symptomatic seizure","justification":"The first part of the statement refers to an epileptic seizure secondary to alcohol withdrawal."},{"idx":4,"correct":true,"proposition":"Delirium tremens","justification":"Confusion, agitation, sweating, and incoherent remarks point to a delirium tremens."}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-15-qi-7","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"The clinical course under treatment is partially favorable. The patient is less agitated but confusion persists. You have contacted his doctor who confirms a significant and daily alcohol consumption, active smoking and social precariousness. By putting the patient in orthostatism, standing appears very unstable and walking is impossible without the help of a third party. During the examination, you notice multidirectional nystagmus and bilateral limitation of eye abduction. \n\nWhich of the following diagnostic hypotheses is compatible with the clinical picture? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Combined sclerosis of the spinal cord","justification":""},{"idx":1,"correct":false,"proposition":"Herpetic encephalitis","justification":""},{"idx":2,"correct":false,"proposition":"Paraneoplastic encephalitis","justification":""},{"idx":3,"correct":true,"proposition":"Gayet-Wernicke encephalopathy","justification":""},{"idx":4,"correct":false,"proposition":"Status epilepticus with confusional expression","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-15-qi-8","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"You mention the diagnosis of Gayet-Wernicke encephalopathy. In general, concerning the pathophysiological mechanism(s) that could explain or increase the symptoms of this pathology, which proposal(s) is(are) accurate? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Recent intake of isolated glucose serum","justification":""},{"idx":1,"correct":false,"proposition":"Presence of specific antibodies","justification":""},{"idx":2,"correct":true,"proposition":"Thiamine (vitamin B1) deficiency","justification":""},{"idx":3,"correct":false,"proposition":"Cobalamin (vitamin B12) deficiency","justification":""},{"idx":4,"correct":true,"proposition":"Inadequate dietary intake","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-15-qi-9","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"A brain MRI is performed. What is the sequence shown below? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Diffusion","justification":""},{"idx":1,"correct":false,"proposition":"T2 FLAIR","justification":"The gray matter (in the periphery) is white, the white matter (in medial) is gray 👉 It is a T2. The liquids are black 👉 It is a T2 FLAIR."},{"idx":2,"correct":false,"proposition":"T2","justification":"The median hypersignal that we see is not CSF, it is a hypersignal of the mammillary bodies that is readily found in deficiency encephalopathies."},{"idx":3,"correct":false,"proposition":"T1 with gadolinium injection","justification":""},{"idx":4,"correct":false,"proposition":"TOF (Time Of Flight) (Angio-MRI)","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-15-qi-10","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"Which of the following proposals for these MRIs is the visible anomaly? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Involvement of medial thalami","justification":"The thalami (plural of thalamus) are just opposite the lateral ventricles and the third ventricle. We can see in the first axial section that they are in hypersignal."},{"idx":1,"correct":true,"proposition":"Hypersignal in the periphery of the third ventricle","justification":"This hypersignal indicates an attack of the thalami."},{"idx":2,"correct":true,"proposition":"Periaqueductal hypersignal","justification":"The Sylvius aqueduct (synonymous with the midbrain aqueduct) is the small pipe that allows CSF communication between the third ventricle (located in the brain) and the fourth ventricle (located between the cerebellum and the brainstem). It is observed on the second axial section: it is in hypersignal (= we have a problem 😥)."},{"idx":3,"correct":false,"proposition":"Protuberantial lesion","justification":"The protuberance is synonymous with the bridge, which is the intermediate structure of the brainstem, making the link between the medulla elongata (synonym of myelencephalon) and the midbrain. We see it in the coronal cup: no hyper\/hypo-signal, everything is fine 👌"},{"idx":4,"correct":false,"proposition":"Damage to white matter","justification":"The white substance is gray on all cuts: there is no hypersignal, everything is fine 👌"}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-15-qi-11","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"You have been diagnosed with Gayet-Wernicke encephalopathy. Which of the following processing proposals are you putting in place now? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Hypertonic solution infusion","justification":""},{"idx":1,"correct":false,"proposition":"Intravenous antiepileptic drugs","justification":""},{"idx":2,"correct":false,"proposition":"Antiplatelet agent","justification":""},{"idx":3,"correct":true,"proposition":"Intravenous vitamin B1 supplementation","justification":"⚠ Single-answer question."},{"idx":4,"correct":false,"proposition":"Parenteral benzodiazepine","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-15-qi-12","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"The clinical course is favorable after three weeks of hospitalization. She therefore presented neurological complications of chronic alcoholism. Biological parameters are standardized except for MCV at 104 μm3. She seems to you to have understood the need for a definitive and total weaning. She keeps an abnormal neuropsychological assessment for her age with some visuospatial disorders, judgment and working memory. Walking is limited in terms of perimeter, cautious with widening of the lifting polygon, and tendency to hang the forefoot. \n\nWhat is (are) your hypothesis(s) to explain the gait disorders presented by this patient? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Apraxia when walking","justification":""},{"idx":1,"correct":true,"proposition":"Static cerebellar syndrome","justification":"Argued by the enlargement of the lift polygon"},{"idx":2,"correct":false,"proposition":"Lacunar syndrome","justification":""},{"idx":3,"correct":true,"proposition":"Polyneuropathy","justification":"Eroded by the deficit of foot lifters"},{"idx":4,"correct":false,"proposition":"Alcoholic myopathy","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-15-qi-13","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"You have been able to gather some social information: the patient lives alone, has no close relative, has been unemployed for 9 months. Regarding medico-social care, what approach(s) will you take? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Application for a disabled adult allowance","justification":"The AAH concerns people who have never worked, with a very high rate of disability. That is not the case here."},{"idx":1,"correct":true,"proposition":"Follow-up by the sector social worker","justification":""},{"idx":2,"correct":true,"proposition":"Proposal for a legal protection measure","justification":""},{"idx":3,"correct":false,"proposition":"Application for long-term illness with Social Security","justification":""},{"idx":4,"correct":false,"proposition":"Temporary suspension of driver's licence","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-15-qi-14","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"You have not heard from this patient again. Six months later, your psychiatrist colleague calls you about him. She is treated in psychiatric emergency for << delirium >>. You go to see it and see a seemingly normal reasoning but you are amazed by its familiarity. It presents significant memory disorders predominant on recent facts but also on older facts. The patient repeatedly asks you about her immediate future when you have already answered the same question several times. \n\nWhich of the following diagnostic proposals is accurate? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Acute drunkenness","justification":""},{"idx":1,"correct":true,"proposition":"Syndrome de Korsakoff","justification":""},{"idx":2,"correct":false,"proposition":"Paraneoplastic encephalitis","justification":""},{"idx":3,"correct":false,"proposition":"Vascular dementia","justification":""},{"idx":4,"correct":false,"proposition":"Status epilepticus with confusional expression","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-15-qi-15","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"Which of the following propositions, are the semiological argument(s) that characterize Korsakoff syndrome? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Oculomotor disorders","justification":"Gayet-Wernicke encephalopathy"},{"idx":1,"correct":false,"proposition":"Spasmodic laughter and crying","justification":"Lacunar syndrome"},{"idx":2,"correct":true,"proposition":"Anterograde amnesia","justification":""},{"idx":3,"correct":true,"proposition":"Fabulations","justification":""},{"idx":4,"correct":true,"proposition":"False acknowledgements","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-16-qi-1","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"After quickly collecting the history and circumstances of occurrence of epistaxis, what is (are) the gesture (s) that you practice quickly? ","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Removal of clots by blowing their nose","justification":""},{"idx":1,"correct":true,"proposition":"Digital nasal compression for ten minutes","justification":""},{"idx":2,"correct":true,"proposition":"Establishment of a venous line","justification":""},{"idx":3,"correct":true,"proposition":"Blood group samples","justification":""},{"idx":4,"correct":true,"proposition":"Assessment of the presence of posterior hemorrhage by pharyngeal examination","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-16-qi-2","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"Regarding the vascularization of the nasal cavities, what is(are) the exact answer(s)?","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Branches of the internal carotid artery vascularize the lower turbinate","justification":""},{"idx":1,"correct":true,"proposition":"Vascularization comes mainly from the branches of the external carotid artery","justification":""},{"idx":2,"correct":true,"proposition":"The main artery is the sphenopalatine artery","justification":""},{"idx":3,"correct":false,"proposition":"The anterior ethmoidal artery is the terminal branch of the external carotid artery","justification":""},{"idx":4,"correct":true,"proposition":"The facial artery participates in the vascularization of the nasal cavities","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-16-qi-3","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"Which element(s) are you looking for during the interrogation?","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The unilateral or bilateral nature of the bleeding","justification":""},{"idx":1,"correct":true,"proposition":"A history of perforation of the nasal septum","justification":""},{"idx":2,"correct":true,"proposition":"The date and value of the last INR","justification":""},{"idx":3,"correct":true,"proposition":"The side with which epistaxis began","justification":""},{"idx":4,"correct":true,"proposition":"The abundance of epistaxis","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-16-qi-4","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"On clinical examination, the patient is pale and sweaty. The epistaxis is both anterior and posterior. Blood pressure is at 150\/95 mmHg with a regular heart rate at 124\/min. The temperature is 37.5 °C and oxygen saturation is 98%. \n\nWhat is (are) the element(s) in favor of severe epistaxis in this patient?","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Pallor","justification":""},{"idx":1,"correct":true,"proposition":"Sweats","justification":""},{"idx":2,"correct":true,"proposition":"Heart rate","justification":""},{"idx":3,"correct":false,"proposition":"Blood pressure","justification":""},{"idx":4,"correct":false,"proposition":"Previous bleeding","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-16-qi-5","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"You take a biological sample. Which biological parameter(s) are you asking for at this stage?","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Ferritin","justification":""},{"idx":1,"correct":true,"proposition":"Coagulation assessment including TP, INR, TCA","justification":""},{"idx":2,"correct":true,"proposition":"HR Group, RAI","justification":""},{"idx":3,"correct":true,"proposition":"Creatinine emia","justification":""},{"idx":4,"correct":true,"proposition":"Blood count","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-16-qi-6","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"A few minutes later, blood pressure is 85\/55 mmHg and heart rate is 130\/min. The patient has some mottling at the knees. What measure(s) do you propose at this stage? (one or more correct answers) ","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Find the cause of epistaxis","justification":"That is not the urgency here. The patient who appears to be in hemorrhagic shock must first be stabilized."},{"idx":1,"correct":true,"proposition":"Vascular filling by isotonic saline","justification":""},{"idx":2,"correct":true,"proposition":"Dry up the bleeding","justification":""},{"idx":3,"correct":false,"proposition":"Introducing intravenous noradrenaline as a continuous infusion","justification":""},{"idx":4,"correct":false,"proposition":"Perform an arteriogram","justification":"It is (almost) never possible to perform interventional radiology on an unstable patient."}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-16-qi-7","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"Vascular filling stabilized hemodynamics. The mottling has disappeared. You want to locate the origin of epistaxis at the level of the nasal cavities. \n\nWhat step(s) is necessary to localize the bleeding? (one or more correct answers) ","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"You blow the patient's nose to evacuate the clots","justification":"Step 1"},{"idx":1,"correct":true,"proposition":"You introduce a wick impregnated with local vasoconstrictor into the hemorrhagic nasal cavity","justification":"Step 2"},{"idx":2,"correct":true,"proposition":"You explore the nasal cavity as a whole","justification":"Step 3"},{"idx":3,"correct":false,"proposition":"You perform an arteriogram","justification":""},{"idx":4,"correct":false,"proposition":"You request a non-injected CT scan of the facial mass","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-16-qi-8","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"The patient is calm and after your endonasal examination you observe unilateral bleeding from the vascular spot. The INR is at 2.5. The rest of the balance sheet is pending. What is (are) the possible option(s) to stop the bleeding? ","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Installation of a double-balloon probe","justification":""},{"idx":1,"correct":true,"proposition":"Primary electrical cauterization of hemorrhagic vessels","justification":"This is a bleeding of the vascular 👉 task cauterization is to be done in first intention."},{"idx":2,"correct":true,"proposition":"Intravenous vitamin K prescription","justification":"The IV route is used here because it is a serious hemorrhage. The patient is not asymptomatic."},{"idx":3,"correct":false,"proposition":"The return home will be authorized in the absence of recurrence of the epistaxis after a surveillance of a few hours","justification":""},{"idx":4,"correct":false,"proposition":"Posterior dabbing with a greasy strand","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-16-qi-9","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"You performed cauterization of the vascular spot. Despite this, epistaxis persisted. You observe significant bleeding without being able to locate the exact origin. What is your immediate attitude? (only one exact answer) ","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Previous tamponade with a greasy strand or hemostatic swab","justification":""},{"idx":1,"correct":false,"proposition":"Anteroposterior buffering by double balloon probe","justification":"As a second intention."},{"idx":2,"correct":false,"proposition":"Discontinuation of vitamin K antagonists","justification":"It's been a long time since we stopped them (and even poured them out)."},{"idx":3,"correct":false,"proposition":"Ligation of ethmoidal arteries","justification":"As a last resort."},{"idx":4,"correct":false,"proposition":"Arteriography with selective embolization","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-16-qi-10","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"Despite a well-performed previous tamponade, you observe an early recurrence of epistaxis. What is your attitude? (only one exact answer) ","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Arteriography with selective embolization","justification":""},{"idx":1,"correct":false,"proposition":"Endonasal ligation of the sphenopalatine artery","justification":"Third intention"},{"idx":2,"correct":false,"proposition":"Anterior ethmoidal artery ligation","justification":"Last intention"},{"idx":3,"correct":false,"proposition":"Posterior ethmoidal artery ligation","justification":""},{"idx":4,"correct":true,"proposition":"Anteroposterior buffering by double balloon probe","justification":"This is the second step"}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-16-qi-11","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"You have managed to dry up epistaxis, and you decide to look for the etiology. Regarding epistaxis << >> symptom, which is (are) the diagnosis(s) that you can evoke? ","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Septal perforation","justification":""},{"idx":1,"correct":true,"proposition":"Complication of endonasal surgery","justification":""},{"idx":2,"correct":true,"proposition":"Tumor cause","justification":""},{"idx":3,"correct":false,"proposition":"Willebrand disease","justification":"It is necessary to differentiate epistaxis << symptom >> (local cause) from epistaxis << epiphenomenon >> (general cause) of which Willebrand and Rendu-Osler disease are part."},{"idx":4,"correct":false,"proposition":"Rendu-Osier disease","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-16-qi-12","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"Regarding epistaxis of general origin (<< epistaxis epiphenomenon >>), what is (are) the diagnosis (s) that you can evoke?","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Thrombopathy","justification":""},{"idx":1,"correct":false,"proposition":"Hemophilia","justification":"Bleeding disorders are expressed more by deep bleeding. In addition, the advanced age and the fact that it is a woman lead us to count this false proposition."},{"idx":2,"correct":true,"proposition":"Granulomatosis with polyangiitis","justification":""},{"idx":3,"correct":false,"proposition":"A rheumatoid purpura","justification":"She's a bit old 🤭"},{"idx":4,"correct":true,"proposition":"HTA at 250\/120 mmHg","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-16-qi-13","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"During the etiological assessment, you ask for a scan of the sinuses. On this coronal CT scan of the sinuses, which is (are) the exact proposal(s):","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"1 represents the right maxillary sinus","justification":""},{"idx":1,"correct":true,"proposition":"2 represents the lower right horn","justification":""},{"idx":2,"correct":true,"proposition":"3 represents the middle left horn","justification":""},{"idx":3,"correct":false,"proposition":"4 represents a tumor mass","justification":""},{"idx":4,"correct":false,"proposition":"4 represents the left posterior turbeach","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-17-qi-1","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"She consults for a rather dry cough evolving for 3 months. This cough has become very disabling and wakes her up at night. You mention the possibility of a cough with ACE inhibitors. Which of the following answers is correct about IEC cough?","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"It contraindicates angiotensin inhibitors II","justification":""},{"idx":1,"correct":false,"proposition":"It is dependent on the dose used","justification":""},{"idx":2,"correct":true,"proposition":"It can affect 5% or more of patients treated with ACE inhibitors","justification":""},{"idx":3,"correct":true,"proposition":"It is linked to a class effect","justification":""},{"idx":4,"correct":false,"proposition":"It usually occurs after an infectious episode","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-17-qi-2","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"You stop its ACE inhibitor and replace it with an angiotensin II inhibitor. The cough decreases in a few days and will disappear in less than 15 days. She has no sputum. The patient nevertheless complains of discomfort during exercise with a feeling of shortness of breath when walking flat quickly and when she climbs a slight slope, which she has noticed for several months when she returns home. You rate his dyspnea in his medical record by the chronic dyspnea scale of modified MRC (modified scale of Medical Research Counci\/). This scale assesses the impact of physical activity on dyspnea. What is the mMRC stage of this patient? ","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Stage 0","justification":"everything is fine we are oklm (important effort like everyone else, even Benzema)"},{"idx":1,"correct":true,"proposition":"Stage 1","justification":"a feeling of shortness of breath when walking flat fast and when climbing a slight slope = mMRC 1"},{"idx":2,"correct":false,"proposition":"Stage 2","justification":"a feeling of shortness of breath when walking with people of his age"},{"idx":3,"correct":false,"proposition":"Stage 3","justification":"a feeling of shortness of breath when walking after a few minutes flat"},{"idx":4,"correct":false,"proposition":"Stage 4","justification":"a feeling of shortness of breath preventing him from going out"}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-17-qi-3","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"You examine the patient. Cardiac auscultation is normal. Pulmonary auscultation finds a diffuse decrease in vesicular murmur without sibilant or crackling. Vocal vibrations are transmitted. The percussion of the thorax is generally tympanic. There is no sign of heart failure either right or left. She weighs 44 kg and is 1.55 m tall. Which clinical sign(s) testify to chest distention? ","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Hoover's sign","justification":"When the patient inhales, the transverse diameter (from right to left) of the chest decreases, whereas normally it should increase."},{"idx":1,"correct":false,"proposition":"Pilgrim edema","justification":""},{"idx":2,"correct":false,"proposition":"Cyanotic lips","justification":""},{"idx":3,"correct":true,"proposition":"Barrel thorax","justification":""},{"idx":4,"correct":false,"proposition":"Digital Hippocratism","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-17-qi-4","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"You carry out a spirometry of which here is the report. Which of the following proposal(s) is correct:","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"You can affirm the existence of an obstructive syndrome","justification":""},{"idx":1,"correct":true,"proposition":"CVL is higher than FVC","justification":""},{"idx":2,"correct":true,"proposition":"There is a significant lack of reversibility","justification":""},{"idx":3,"correct":false,"proposition":"You can claim chronic respiratory failure","justification":""},{"idx":4,"correct":false,"proposition":"You can affirm chest distension","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-17-qi-5","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"You complete the examinations with a front chest x-ray and more complete pulmonary function tests (RFS). Taking into account clinical history, clinical examination, imaging and EFRs, it is true that: ","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"You can claim chronic respiratory failure","justification":""},{"idx":1,"correct":true,"proposition":"You can affirm chest distension","justification":""},{"idx":2,"correct":true,"proposition":"You mention COPD"},{"idx":3,"correct":true,"proposition":"You suspect emphysema"},{"idx":4,"correct":false,"proposition":"You prescribe long-term oxygen therapy","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-17-qi-6","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"Given the clinical chest distension, chest distension on the lung X-ray with flattening of the diaphragmatic cupolas and EFRs you retain the diagnosis of COPD, probably in connection with emphysema, especially since there is an impairment of the diffusion. You explain to the patient that this disease is directly related to smoking and that quitting smoking will be essential. You assess his pharmacological\/nicotine dependence via the Fagerström test. \n\nWhich element(s) is (are) in favor of a strong pharmacological dependence? ","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Inhale smoke completely","justification":""},{"idx":1,"correct":false,"proposition":"Smoking brown tobacco","justification":""},{"idx":2,"correct":true,"proposition":"Smoking more than 30 cigarettes a day","justification":""},{"idx":3,"correct":true,"proposition":"Smoking a cigarette as soon as you wake up","justification":""},{"idx":4,"correct":false,"proposition":"Roll your own cigarettes","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-17-qi-7","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"After assessing her tobacco use and conducting a motivational interview, you find that the patient is motivated to quit smoking completely. She has a significant pharmacological dependence on nicotine with the first cigarette smoked within 5 minutes after waking up and again between 21 and 30 cigarettes a day. She does not consume other psychoactive products. You first prescribe nicotine substitutes in oral form. \n\nWhat is the exact proposal(s)? ","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"He will have to be prescribed a dose of 10 mg per day of nicotine","justification":""},{"idx":1,"correct":false,"proposition":"There is no support or refund","justification":""},{"idx":2,"correct":true,"proposition":"Nicotine substitutes have few side effects","justification":""},{"idx":3,"correct":true,"proposition":"Nicotine replacement therapy is more effective than placebo in cases of physical dependence","justification":""},{"idx":4,"correct":false,"proposition":"Nicotine substitutes are prescribed in his off-label case because of the cardiovascular history","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-17-qi-8","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"The patient will be able to quit smoking overnight, thanks in part to nicotine substitutes that you will be able to stop very gradually. She has never had an acute episode of worsening respiratory disease to date. As part of the treatment of his GCP0, what measure(s) to accompany the pharmacological management will you put in place? ","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Work stoppage","justification":""},{"idx":1,"correct":true,"proposition":"Physical Activity Tips","justification":""},{"idx":2,"correct":false,"proposition":"Low salt diet","justification":""},{"idx":3,"correct":false,"proposition":"Eviction of latex","justification":""},{"idx":4,"correct":true,"proposition":"Annual influenza and pneumococcal vaccinations","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-17-qi-9","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"You carry out the necessary vaccinations. Regarding his drug treatments, what is (are) the exact proposal(s)? ","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"You contraindicate its beta-blocker treatment","justification":"The patient does not have asthma."},{"idx":1,"correct":true,"proposition":"You prescribe a short-acting bronchodilator on demand","justification":"Every COPD patient should carry their BDCA."},{"idx":2,"correct":true,"proposition":"You prescribe a long-acting bronchodilator once or twice a day","justification":""},{"idx":3,"correct":false,"proposition":"You prescribe an inhaled corticosteroid as part of a fixed combination","justification":""},{"idx":4,"correct":false,"proposition":"You prescribe loop diuretics in moderate doses","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-17-qi-10","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"Despite the treatments put in place, the patient still has dyspnea of the mMRC stage. You are considering pulmonary rehabilitation. Regarding the latter, its effectiveness has been demonstrated on:","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Exercise capacity","justification":""},{"idx":1,"correct":true,"proposition":"Consumption of care","justification":""},{"idx":2,"correct":true,"proposition":"Dyspnea","justification":""},{"idx":3,"correct":true,"proposition":"Quality of life","justification":""},{"idx":4,"correct":false,"proposition":"FEV1","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-17-qi-11","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"The patient benefited greatly from pulmonary rehabilitation. Two years later, she is retired and comes to see you again in consultation because she feels much more breathless for a few days while her condition was quite stable until then. This increase in dyspnea is associated with the reappearance of a cough and purulent sputum. You suspect an exacerbation of COPD. What is the exact proposal(s)?","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The majority of COPD exacerbations are infectious (viral, bacterial, or mixed)","justification":""},{"idx":1,"correct":false,"proposition":"The first exacerbation is usually not serious","justification":""},{"idx":2,"correct":true,"proposition":"The diagnosis of exacerbation is based on increased dyspnea, cough and\/or sputum","justification":""},{"idx":3,"correct":true,"proposition":"The main argument in favor of a bacterial infection is sputum purulence","justification":""},{"idx":4,"correct":false,"proposition":"The bacteria most often involved are Haemophilus influenzae, Pseudomonas aeruginosa and Moraxella catarrhalis","justification":"The 3 bacteria to know are: Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis. Pseudomonas aeruginosa is rarer, but more serious."}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-17-qi-12","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"She was admitted to the emergency room of the hospital. The nurse who takes care of her calls you because she is worried. You will find paradoxical abdominal breathing on clinical examination. Regarding paradoxical abdominal breathing, what is (are) the true proposition(s)? ","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"It is defined as the receding of the anterior wall of the abdomen during inspiration instead of the expected abdominal expansion","justification":""},{"idx":1,"correct":false,"proposition":"This is an active abdominal exhalation","justification":""},{"idx":2,"correct":true,"proposition":"Its presence indicates the absence of participation of the diaphragm in the ventilation which is then taken care of by the extra-diaphragmatic inspiratory muscles","justification":"That's what makes it serious."},{"idx":3,"correct":true,"proposition":"Its finding requires the admission of the patient to a structure where ventilatory assistance can be set up without delay.","justification":""},{"idx":4,"correct":true,"proposition":"Its presence raises fears of short-term failure","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-17-qi-13","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"You will immediately transfer the patient to respiratory intensive care. Chest X-ray does not find an infectious focus or pneumothorax. Analysis of blood gases in ambient air shows a pH of 7.35, a PaO at 50 mmHg and a PaCO2 at 48 mmHg, HCO3- at 26 mmol \/ L.  What treatment(s) will you put in place? ","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Nebulizing bronchodilators","justification":""},{"idx":1,"correct":true,"proposition":"Systematic antibiotic therapy","justification":"The patient shows signs of severity. This is an indication for antibiotic therapy."},{"idx":2,"correct":true,"proposition":"Chest physiotherapy","justification":"Chest physiotherapy is offered acutely in case of significant bronchial secretions."},{"idx":3,"correct":true,"proposition":"Oxygen therapy with a titrated oxygen flow rate to obtain a pulsed oxygen saturation (Sp02) between 88% and 92%","justification":""},{"idx":3,"correct":false,"proposition":"3-week systemic corticosteroid therapy","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-17-qi-14","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"The evolution is favorable with the treatment implemented without the need for mechanical ventilation. She can be discharged from hospital 8 days later. She gradually returns to her usual state. You see her again 6 months later because she has just presented some sputum of pure blood during a coughing effort. She has no other symptoms elsewhere. His dyspnea is not increased. What is the exact proposal(s)? ","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"In the context of this patient, bronchial cancer must be ruled out until proven otherwise.","justification":""},{"idx":1,"correct":false,"proposition":"The administration of vitamin K should be carried out as a matter of urgency as a matter of principle","justification":""},{"idx":2,"correct":false,"proposition":"Taking the antiaggregant may be the cause of hemoptysis in this context of COPD","justification":"⚠ Recurrent pitfall: COPD is not a cause of hemoptysis."},{"idx":3,"correct":true,"proposition":"Chest computed tomography injected with arterial time is the key examination and will be performed if possible even before a bronchial endoscopy.","justification":""},{"idx":4,"correct":true,"proposition":"Despite good tolerance, management should be considered an emergency","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-18-qi-1","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"What element(s) are you looking for questioning about these pains to advance in your diagnostic hypotheses? ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Belt irradiation","justification":""},{"idx":1,"correct":false,"proposition":"Association with headache","justification":"He's a little too young for a Horton 😅"},{"idx":2,"correct":true,"proposition":"Decrease during meals","justification":""},{"idx":3,"correct":true,"proposition":"Acute or progressive affixing mode","justification":""},{"idx":4,"correct":false,"proposition":"Improvement through arm elevation","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-18-qi-2","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"In this patient, what etiology(s) should you mention? ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Bronchial cancer","justification":""},{"idx":1,"correct":true,"proposition":"Spondyloarthritis","justification":""},{"idx":2,"correct":false,"proposition":"Thoracic aorta dissection","justification":""},{"idx":3,"correct":false,"proposition":"Sequelae of vertebral growth epiphysitis","justification":""},{"idx":4,"correct":true,"proposition":"Duodenal ulcer","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-18-qi-3","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"The pain settled gradually over two months. Which element(s) point to the inflammatory nature of the pain in this patient? ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Persistence despite rest","justification":""},{"idx":1,"correct":true,"proposition":"Awakening at night","justification":""},{"idx":2,"correct":false,"proposition":"Difficulty falling asleep","justification":""},{"idx":3,"correct":false,"proposition":"Progressive worsening of pain","justification":""},{"idx":4,"correct":true,"proposition":"Improvement after one hour of activity in the morning","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-18-qi-4","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"On clinical examination, the pain is maximum on palpation of the spinous located opposite the two points of scapula. At what spinal level does this localization correspond? ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"1st thoracic vertebra","justification":""},{"idx":1,"correct":false,"proposition":"2nd thoracic vertebra"},{"idx":2,"correct":false,"proposition":"4th thoracic vertebra"},{"idx":3,"correct":true,"proposition":"7th thoracic vertebra","justification":"🤷‍♂️"},{"idx":4,"correct":false,"proposition":"11th thoracic vertebra","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-18-qi-5","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"In front of this inflammatory back pain located at the level of the 7th thoracic vertebra, what are you looking for in priority at the clinical examination? (one or more correct answers)","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Sign of Lasègue","justification":""},{"idx":1,"correct":true,"proposition":"Hypoaesthesia band"},{"idx":2,"correct":true,"proposition":"Abnormality of spine statics"},{"idx":3,"correct":true,"proposition":"Hyperthermia","justification":""},{"idx":4,"correct":false,"proposition":"Sign of Hoffman","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-18-qi-6","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"What exam(s) do you prescribe in the first line for this patient? ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"D-dimer","justification":""},{"idx":0,"correct":true,"proposition":"CRP","justification":""},{"idx":0,"correct":true,"proposition":"Complete blood count","justification":""},{"idx":0,"correct":false,"proposition":"TSH","justification":""},{"idx":0,"correct":false,"proposition":"PSA","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-18-qi-7","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"There is no inflammatory syndrome and the CBC is without abnormalities. A systematic ECG is normal. Why do you decide to do imaging tests? ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"The duration of symptom evolution","justification":"< 3 months"},{"idx":1,"correct":false,"proposition":"The age of the patient","justification":""},{"idx":2,"correct":true,"proposition":"The localization of pain","justification":""},{"idx":3,"correct":true,"proposition":"The schedule of pain","justification":""},{"idx":4,"correct":false,"proposition":"History of ulcer","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-18-qi-8","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"In this patient with inflammatory back pain with a normal biological assessment, which imaging examination seems most relevant to you at this stage? (only one answer expected) ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Chest X-ray","justification":""},{"idx":1,"correct":false,"proposition":"Cardiac ultrasound","justification":""},{"idx":2,"correct":false,"proposition":"Thoraco-abdomino-pelvic CT scan","justification":""},{"idx":3,"correct":true,"proposition":"Spinal MRI","justification":""},{"idx":4,"correct":false,"proposition":"Bone scintigraphy","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-18-qi-9","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"MRI of the entire spine performed quickly is normal. At the follow-up consultation one month later, the back pain gradually and spontaneously improved within a month. The patient makes an appointment with you three months later because he has had pain in his right knee for 2 days. What are you looking for on the physical exam? (one or more correct answers) ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Clinostatism","justification":""},{"idx":1,"correct":true,"proposition":"A knee injury","justification":""},{"idx":2,"correct":true,"proposition":"A patellar shock","justification":""},{"idx":3,"correct":false,"proposition":"A plantar skin reflex","justification":""},{"idx":4,"correct":true,"proposition":"Pain of the lateral edge of the knee during its extension (sign of the windshield wiper)","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-18-qi-10","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"There is patellar shock of the right knee. The patient has a temperature of 37.3 °C. You are wondering about performing a knee puncture. What is the true statement? ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"It is necessary to puncture the knee because there is an effusion","justification":""},{"idx":1,"correct":false,"proposition":"Do not puncture the knee because the pain has been evolving for less than 7 days","justification":""},{"idx":2,"correct":false,"proposition":"Do not puncture the knee because the temperature is normal","justification":""},{"idx":3,"correct":false,"proposition":"Do not puncture the knee because the patient is young","justification":""},{"idx":4,"correct":false,"proposition":"Do not puncture the knee because there is a risk of infecting the knee","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-18-qi-11","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"You decide to perform a joint puncture of the right knee. Which statement(s) is the correct statement(s)?","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"The patient must be seated","justification":""},{"idx":1,"correct":true,"proposition":"The procedure requires an antiseptic skin preparation","justification":""},{"idx":2,"correct":false,"proposition":"Prophylactic antibiotic therapy is needed","justification":""},{"idx":3,"correct":true,"proposition":"Cytological examination of the fluid is essential","justification":""},{"idx":4,"correct":false,"proposition":"Written consent from the patient must be obtained prior to the procedure","justification":"There are very few actions that require written consent. Punctures are not part of it (except genetic test)."}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-18-qi-12","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"The joint puncture fluid has 5500\/mm3 leukocytes. Germs are not found on direct examination or after cultivation. There are no microcrystals.\nWhich etiology(ies) is(are) the most likely?","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A flare-up of osteoarthritis"},{"idx":1,"correct":false,"proposition":"One drop"},{"idx":2,"correct":true,"proposition":"Spondyloarthritis"},{"idx":3,"correct":false,"proposition":"Lupus"},{"idx":4,"correct":false,"proposition":"Osteonecrosis"}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-18-qi-13","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"You suspect spondyloarthritis. What are you doing to support this diagnosis? (one or more correct answers) ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Search for a rocking fessalgia","justification":""},{"idx":1,"correct":true,"proposition":"Search for heel pain","justification":""},{"idx":2,"correct":true,"proposition":"Search for familial psoriasis","justification":""},{"idx":3,"correct":true,"proposition":"Looking for a history of finger in << sausage>>","justification":""},{"idx":4,"correct":false,"proposition":"Conducting an NSAID test","justification":"Ulcer history makes prescribing NSAIDs somewhat annoying 🤭"}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-18-qi-14","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"The search for the HLA B27 gene is positive. The patient is worried and asks you questions. What do you say to him? (one or more correct answers) ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"The presence of HLA B27 in the blood is variable over the course of life","justification":"Either the protein is there or it is not."},{"idx":1,"correct":false,"proposition":"The presence of HLA B27 requires the protection of your partner during sexual intercourse","justification":""},{"idx":2,"correct":false,"proposition":"You have to do the research in your children","justification":""},{"idx":3,"correct":true,"proposition":"HLA B27 is present in more than 90% of patients with ankylosing spondylitis","justification":""},{"idx":4,"correct":true,"proposition":"The vast majority of HLA B27+ subjects will never have spondyloarthritis","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2020-dp-18-qi-15","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"The patient asks you for advice regarding his long-term management. What measure(s) do you recommend? ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Gluten-free diet","justification":""},{"idx":1,"correct":true,"proposition":"Regular physical activity","justification":""},{"idx":2,"correct":true,"proposition":"Smoking cessation","justification":""},{"idx":3,"correct":false,"proposition":"Nonsteroidal anti-inflammatory drugs for flare-ups","justification":"He cannot be recommended NSAIDs per se because of his history of ulcer."},{"idx":4,"correct":false,"proposition":"Eviction of cow's milk","justification":""}],"ts":{"$numberLong":"1665228949807"},"type":"dp"}
-{"_id":"annales-2022-dp-1-qi-1","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":"What elements of the interrogation are you looking for to support this diagnosis? (one or more expected answers)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":" Spasmodic abdominal pain","justification":""},{"idx":1,"correct":true,"proposition":"Glairo-bloody emissions","justification":""},{"idx":2,"correct":false,"proposition":"Presence of watery stools","justification":""},{"idx":3,"correct":true,"proposition":"oozing","justification":""},{"idx":4,"correct":true,"proposition":"Description of spurs","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-1-qi-2","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" The patient reports spurs relieved by glairo-bloody emissions, which reinforces your hypothesis of proctitis. You learn that the patient has unprotected sex with episodic male partners. What arguments are you looking for in favor of an infectious etiology? (one or more expected answers)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Polyarthralgia","justification":""},{"idx":1,"correct":false,"proposition":"Mouth ulcers","justification":""},{"idx":2,"correct":true,"proposition":"Mucopurulent anal discharge","justification":""},{"idx":3,"correct":true,"proposition":"Inguinal lymphadenopathy","justification":""},{"idx":4,"correct":true,"proposition":"Fever","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-1-qi-3","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" The patient describes tenesmus but no muco-purulent discharge. There is no fever or deterioration in the general condition. The weight is 65 kg for a height of 1m70. The clinical examination does not find inguinal lymphadenopathy. The abdominal wall is not sensitive. What, at this stage, are the etiological hypotheses concerning this suspicion of proctitis? (one or more expected answers)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Salmonella infection","justification":""},{"idx":1,"correct":false,"proposition":"Shigella infection","justification":""},{"idx":2,"correct":true,"proposition":"Ulcerative colitis","justification":""},{"idx":3,"correct":true,"proposition":"Sexually transmitted infection","justification":""},{"idx":4,"correct":true,"proposition":"Amoebiasis","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-1-qi-4","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" What are the additional first-line examinations to be performed? (one or more expected answers)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Coproculture","justification":""},{"idx":1,"correct":true,"proposition":"Microbiological collection by rectal swab","justification":""},{"idx":2,"correct":true,"proposition":"Recto-sigmoidoscopy with biopsy for histopathological examination","justification":""},{"idx":3,"correct":true,"proposition":"Stool parasitology","justification":""},{"idx":4,"correct":true,"proposition":"HIV serology","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-1-qi-5","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" Rectal swab with PCR examination does not find Chlamydia trachomatis or Neisseria gonorrhoeae. HIV serology is negative. Parasitological examination of stool is negative. Endoscopic examination shows a rectal mucosa of granite appearance with erosions that bleed on contact with the endoscope. The lesions do not extend beyond the rectosigmoid hinge and the sigmoid mucosa is normal. Histological examination shows glandular distortions, cryptic abscesses and an inflammatory infiltrate of the chorion, consisting of lymphoplasmocytes and polynuclear cells. The diagnosis of ulcerative colitis is retained. You propose treatment with 5-amino-salicylates rectally. What information do you give the patient about their illness? (one or more expected answers)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Treatment can cure the disease permanently","justification":""},{"idx":1,"correct":true,"proposition":"A severe pancolic flare-up is possible","justification":""},{"idx":2,"correct":true,"proposition":"The risk of colorectal cancer is increased compared to the general population","justification":""},{"idx":3,"correct":false,"proposition":"The risk of primary biliary cirrhosis is increased compared to the general population","justification":""},{"idx":4,"correct":false,"proposition":"The risk of diverticular disease is increased compared to the general population","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-1-qi-6","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" The patient received maintenance therapy with 5 amino-salicylate suppository for 18 months. A few months later, after a period during which he was asymptomatic without treatment, he reported the presence of blood accompanying the stool for 15 days, without abdominal pain. What data do you seek, during the interrogation, in favor of a hemorrhoidal pathology at the origin of bleeding? (one or more expected answers)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Bleeding after defecation","justification":""},{"idx":1,"correct":true,"proposition":"Presence of pain per and post defecatory","justification":""},{"idx":2,"correct":false,"proposition":"Presence of mucus in the stool","justification":""},{"idx":3,"correct":true,"proposition":"Exemption from hard stools","justification":""},{"idx":4,"correct":false,"proposition":"Presence of spontaneous anal discharge containing traces of blood","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-1-qi-7","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" A colonoscopy is therefore performed and shows cicatricial proctitis and congestive hemorrhoids without procidence in the lumen of the anal canal. What support do you envisage? (one or more expected answers)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Rectal derivatives 5 amino-salicylates","justification":""},{"idx":1,"correct":true,"proposition":"Laxatives based on mucilages","justification":""},{"idx":2,"correct":true,"proposition":"Lubricating suppositories","justification":""},{"idx":3,"correct":false,"proposition":"Short course of nonsteroidal anti-inflammatory drugs","justification":""},{"idx":4,"correct":false,"proposition":"Surgical consultation to consider hemorrhoidectomy","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-1-qi-8","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" The symptomatology improved after a few days of treatment with lubricating suppositories and mucilage-based laxatives. During the follow-up, you carry out an assessment that objective: Hemoglobin: 14 g \/ dL \/ VGM: 85 fL \/ Leukocytes: 8.5 G \/ L \/ Polynuclear neutrophils: 5.3 G \/ L \/ Lymphocytes: 2.8 g \/ L \/ CRP: 6 mg \/ L \/ Ferritinemia: 80 μg \/ L (N: 50 -200 μg \/ L) \/ AST: 52 IU (N<35). What do you suspect?","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Hepatic colic","justification":""},{"idx":1,"correct":false,"proposition":"Cholangitis","justification":""},{"idx":2,"correct":false,"proposition":"Primary biliary cholangitis","justification":""},{"idx":3,"correct":false,"proposition":"Autoimmune hepatitis","justification":""},{"idx":4,"correct":true,"proposition":"Primary sclerosing cholangitis","justification":"This question was a hidden QRU"}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-1-qi-9","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" You suspect primary sclerosing cholangitis. What diagnostic tests do you perform as a first-line treatment? (one or more expected answers)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Hepatobiliary ultrasound","justification":""},{"idx":1,"correct":false,"proposition":"Biliary scintigraphy","justification":""},{"idx":2,"correct":true,"proposition":"Bili-MRI","justification":""},{"idx":3,"correct":false,"proposition":"High endoscopic echo","justification":""},{"idx":4,"correct":false,"proposition":"Endoscopic retrograde cholangiopancreatography","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-1-qi-10","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" Bili-MRI and ultrasound show a succession of dilatations and strictures of the bile duct, which suggests primitive sclerosing cholangitis. The patient is lost to follow-up and consults the emergency room 5 years later for jaundice associated with chills. Its vital parameters are: PA 130\/80 mmHg, FC92\/min, temperature 38.7°C.  There is no marbling. The biological assessment shows:Leukocytes 14 G\/LPolynuclear neutrophils 11.3 G\/LLymphocytes 2.6 G\/LCRP: 98 mg\/LASAT: 356 IU (N<35)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Bili-MRI","justification":""},{"idx":1,"correct":false,"proposition":"Upper endoscopic echoendoscopy","justification":""},{"idx":2,"correct":true,"proposition":"Hepatobiliary ultrasound","justification":""},{"idx":3,"correct":false,"proposition":"Liver CT scan","justification":""},{"idx":4,"correct":false,"proposition":"Endoscopic retrograde cholangiography","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-1-qi-11","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" Hepatobiliary ultrasound shows dilation of the intra- and extra-hepatic bile ducts upstream of stenosis of the main bile duct. What support do you offer? (one or more expected answers)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Corticosteroid therapy","justification":""},{"idx":1,"correct":true,"proposition":"Antibiotic therapy","justification":"This proposal was essential"},{"idx":2,"correct":false,"proposition":"Cholecystectomy","justification":""},{"idx":3,"correct":false,"proposition":"Ursodeoxycolic acid","justification":""},{"idx":4,"correct":true,"proposition":"Endoscopic retrograde cholangiography","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-1-qi-12","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" In this patient, which antibiotics are essential in the first line? (one or more expected answers)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Clindamycin","justification":""},{"idx":1,"correct":true,"proposition":"Cefotaxime","justification":""},{"idx":2,"correct":false,"proposition":"Amoxicillin","justification":""},{"idx":3,"correct":false,"proposition":"Vancomycin","justification":""},{"idx":4,"correct":false,"proposition":"Gentamicin","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-1-qi-13","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" You choose antibiotic therapy with cefotaxime and intravenous metronidazole. Which of the bacteria potentially involved in this infection is naturally resistant to the selected antibiotic therapy? (only one answer expected)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Enterococcus faecalis","justification":"This question was a QRU"},{"idx":1,"correct":false,"proposition":"Escherichia coli","justification":""},{"idx":2,"correct":false,"proposition":"Klebsiella pneumoniae","justification":""},{"idx":3,"correct":false,"proposition":"Streptococcus mitis","justification":""},{"idx":4,"correct":false,"proposition":"Bacteroides fragilis","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-1-qi-14","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" In addition to antibiotic therapy, with a view to stenting, the patient benefits from endoscopic retrograde cholangiopancreatography. The latter shows biliary stenosis with dilation of the bile ducts upstream. What are the following structures? (one or more expected answers)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"1 is the gallbladder","justification":""},{"idx":1,"correct":false,"proposition":"2 is the common hepatic duct","justification":""},{"idx":2,"correct":false,"proposition":"3 is the fourth portion of the duodenum","justification":""},{"idx":3,"correct":true,"proposition":"4 corresponds to an intrahepatic bile duct","justification":""},{"idx":4,"correct":false,"proposition":"5 is the main pancreatic duct","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-2-qi-1","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" As part of its follow-up, you request a blood count that shows: red blood cells 3.1 T\/L, hemoglobin 105 g\/L, MCV 105 fl, MCHC 32 g\/dl, leukocytes 4.8 G\/L, neutrophils 2.8 G\/L, eosinophilic polynuclear 0.2 G\/L, lymphocytes 1.4 G\/L, monocytes 0.4 G\/L, platelets 152 G\/L.","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Reticulocytes","justification":""},{"idx":1,"correct":false,"proposition":"Creatinine emia","justification":""},{"idx":2,"correct":false,"proposition":"GammaGT","justification":""},{"idx":3,"correct":false,"proposition":"Dosage vitamins B9 and B12","justification":""},{"idx":4,"correct":false,"proposition":"Ferritinemia","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-2-qi-2","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" The assessment you had done shows reticulocytes at 2.5%. Which exams do you think are relevant? (one or more possible answers)","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"TSH","justification":""},{"idx":1,"correct":true,"proposition":"Creatinine clearance","justification":""},{"idx":2,"correct":false,"proposition":"Direct Coombs test","justification":""},{"idx":3,"correct":true,"proposition":"Dosage vitamins B9 and B12","justification":""},{"idx":4,"correct":false,"proposition":"Ferritinemia","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-2-qi-3","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" The assessment carried out shows a normal TSH, the creatinine clearance evaluated on serum creatinine is normal and dosages of vitamins B9 and B12 within normal limits. You write her a letter for a hematologist, whom she does not decide to consult until 6 months later. The NFS made on the day of the consultation shows: red blood cells 2.1 T\/L, hemoglobin 79 g\/L, MCV 110 fl, MCDC 34.3 g\/dl, reticulocytes 33 G\/L, leukocytes 3.9 G\/L, neutrophils 1.7 G\/L, eosinophils 0.2 G\/L, lymphocytes 1.4 G\/L, monocytes 0.6 G\/L, platelets 112 G\/L. On reading the blood smear, lecytologist notes signs of dysgranulopoiesis but no blast. What are the reasons for diagnosing myelodysplasia? (one or more possible answers)","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"history of chemotherapy","justification":""},{"idx":1,"correct":false,"proposition":"dyslipidemia treated with simvastatin","justification":""},{"idx":2,"correct":false,"proposition":"chronic alcoholism","justification":""},{"idx":3,"correct":true,"proposition":"dysgranulopoiesis on the blood smear","justification":""},{"idx":4,"correct":true,"proposition":"progressive worsening of cytopenias","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-2-qi-4","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" Which exams do you think are indicated at this stage? (one or more possible answers)","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Osteomedullary biopsy","justification":""},{"idx":1,"correct":true,"proposition":"Myelogram","justification":""},{"idx":2,"correct":true,"proposition":"Medullary karyotype","justification":""},{"idx":3,"correct":false,"proposition":"Hemoglobin electrophoresis","justification":""},{"idx":4,"correct":false,"proposition":"Search for the BCR-ABL1 transcript","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-2-qi-5","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" The myelogram shows a rich marrow with granular line 40%, of which 8% blasts, erythroblastic line 45%, lymphocytes 10%, monocytes 5%. Megakaryocytes are numerous. There are signs of dyserythropoiesis, dysgranulopoiesis, and dysmegakaryopoiesis. What diagnoses do you mention? (one or more correct answers)","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"acute myelogenous leukemia","justification":""},{"idx":1,"correct":false,"proposition":"chronic myelogenous leukemia","justification":""},{"idx":2,"correct":true,"proposition":"refractory anemia with excess blasts","justification":""},{"idx":3,"correct":false,"proposition":"megakaryoblastic leukemia","justification":""},{"idx":4,"correct":false,"proposition":"myeloma","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-2-qi-6","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" It is therefore a refractory anemia with excess blasts type 1.At first, you decide to transfuse the patient. She was never transfused and did not become pregnant. What needs to be done? (one or more possible answers)","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"the determination of the ABO Rhesus group must be carried out on two different samples","justification":""},{"idx":1,"correct":false,"proposition":"compatibility must be determined twice on the same sample","justification":""},{"idx":2,"correct":true,"proposition":"a search for irregular agglutinins is justified","justification":""},{"idx":3,"correct":false,"proposition":"the determination of the ABO group is sufficient for globular concentrates","justification":""},{"idx":4,"correct":false,"proposition":"the patient must receive irradiated red blood cells","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-2-qi-7","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" You propose to your patient to participate in a clinical trial testing a hypomethylating agent, an investigational drug that does not have the MA. About the patient's consent, what propositions are true? (one or more possible answers)","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"consent to participate in the trial may be given orally","justification":""},{"idx":1,"correct":true,"proposition":"consent must be signed by the patient and physician","justification":""},{"idx":2,"correct":true,"proposition":"consent must be signed without constraint and preceded by informed information","justification":""},{"idx":3,"correct":true,"proposition":"the information given to the patient before the possible signing of the consent can be given to him without the presence of a third party","justification":""},{"idx":4,"correct":false,"proposition":"Free and informed consent commits the patient to participate in the trial until its completion","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-2-qi-8","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" The hypomethylating investigational medicinal product has already been tested in phase I and its dose and pharmacokinetics have been determined. The trial you are proposing to your patient is a phase II trial. Which propositions are true? (one or more possible answers)","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"a phase II trial may include randomization","justification":""},{"idx":1,"correct":true,"proposition":"a phase II trial evaluates the effectiveness of a drug","justification":""},{"idx":2,"correct":true,"proposition":"a phase II trial must conventionally, if successful, be followed by a phase III trial to obtain a marketing authorization","justification":""},{"idx":3,"correct":true,"proposition":"phase II trials can test drug combinations","justification":""},{"idx":4,"correct":false,"proposition":"patients in phase II trials are generally advanced\/refractory","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-2-qi-9","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" The patient agrees to the clinical trial. It is warned of the risk of worsening cytopenias induced by the proposed treatment. What types of infections does severe neutropenia expose the patient to? (one or more possible answers)","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Bacterial pneumonia","justification":""},{"idx":1,"correct":false,"proposition":"Influenza","justification":""},{"idx":2,"correct":true,"proposition":"Gingivostomatitis","justification":""},{"idx":3,"correct":false,"proposition":"Pneumocystis jirovecii infection","justification":""},{"idx":4,"correct":true,"proposition":"Cellulitis","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-2-qi-10","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" During this treatment exposing to a risk of thrombocytopenia, what semiological elements would suggest a risk of serious bleeding? (one or more possible answers)","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Purpura of the lower limbs","justification":""},{"idx":1,"correct":true,"proposition":"Intraoral hemorrhagic bubbles","justification":""},{"idx":2,"correct":false,"proposition":"Gingivoragies brushing teeth","justification":""},{"idx":3,"correct":false,"proposition":"Conjunctival hemorrhage","justification":""},{"idx":4,"correct":true,"proposition":"Bleeding at the back of the eye","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-2-qi-11","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" She receives 6 monthly cures quite well tolerated but she remains cytopenic. She is rehospitalized one week before her 7th cure for alteration of the general condition with dyspnea of recent installation. The CBC shows hemoglobin at 65 g\/L, leukocytes at 98 G\/L with 80% myeloid blasts and platelets at 15 G\/L. The patient was admitted to the emergency department and transfused overnight. The next morning, she is very dyspneic. What are the two most likely diagnostic hypotheses to explain this dyspnea?","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"alveolar proteinosis","justification":""},{"idx":1,"correct":true,"proposition":"pulmonary edema of overload","justification":""},{"idx":2,"correct":false,"proposition":"pulmonary edema post-transfusion lesional","justification":""},{"idx":3,"correct":true,"proposition":"pulmonary leukostasis","justification":""},{"idx":4,"correct":false,"proposition":"plasma hyperviscosity","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-2-qi-12","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" The diagnosis finally retained is that of pulmonary edema of overload and dyspnea regresses rapidly under diuretic treatment. The patient is transferred to haematology for the management of her transformation into acute leukaemia. A hemostasis assessment shows: TP 30%, TCA patient\/control ratio 1.8, fibrinogen 0.7 g \/ l. D-dimer is at 9000 ng\/ml.How do you interpret this hemostasis assessment in this context? (one or more possible answers)","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Hepatocellular insufficiency","justification":""},{"idx":1,"correct":false,"proposition":"Acquired Willebrand disease","justification":""},{"idx":2,"correct":false,"proposition":"Antiphospholipid syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Disseminated intravascular coagulation","justification":""},{"idx":4,"correct":false,"proposition":"Cold agglutinin disease","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-2-qi-13","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" The diagnosis of DICD is mentioned, so the patient leaves the clinical trial. A cytoreductive treatment is started to try to reduce blast proliferation. The patient becomes oliguric and serum creatinine doubles in 24 hours. Which diagnosis do you think is most likely?","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Rapidly progressive glomerulonephritis","justification":""},{"idx":1,"correct":false,"proposition":"Thrombotic microangiopathy","justification":""},{"idx":2,"correct":true,"proposition":"Tumor lysis syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Rhabdomyolysis","justification":""},{"idx":4,"correct":false,"proposition":"Thrombosis of a renal artery","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-2-qi-14","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" A tumor lysis syndrome is evoked, what biological argument(s) would be in favor of this diagnosis? (one or more possible answers)","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Hypokalemia","justification":""},{"idx":1,"correct":true,"proposition":"Hypocalcemia","justification":""},{"idx":2,"correct":true,"proposition":"Hyperuricemia","justification":""},{"idx":3,"correct":false,"proposition":"Hypophosphoremia","justification":""},{"idx":4,"correct":false,"proposition":"Hyperbilirubinemia","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-3-qi-1","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" Express in pack-years the smoking consumption of this man (only one answer expected)","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"54","justification":""},{"idx":1,"correct":false,"proposition":"44","justification":""},{"idx":2,"correct":false,"proposition":"27","justification":""},{"idx":3,"correct":false,"proposition":"22","justification":""},{"idx":4,"correct":false,"proposition":"14","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-3-qi-2","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" With the elements you have, what hypothesis(s) diagnosis (s) do you retain?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Upper airway infection","justification":""},{"idx":1,"correct":false,"proposition":"Acute respiratory failure","justification":""},{"idx":2,"correct":true,"proposition":"Exacerbation of chronic bronchitis","justification":""},{"idx":3,"correct":false,"proposition":"Alveolar pneumonia","justification":""},{"idx":4,"correct":false,"proposition":"Influenza","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-3-qi-3","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" What element(s) would be important to define the antibiotic therapeutic strategy?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Exact volume of sputum","justification":""},{"idx":1,"correct":true,"proposition":"Presence of exertional dyspnea","justification":""},{"idx":2,"correct":true,"proposition":"Presence of resting dyspnea","justification":""},{"idx":3,"correct":false,"proposition":"Excessive alcohol consumption","justification":""},{"idx":4,"correct":false,"proposition":"Winter context","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-3-qi-4","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" During a new interrogation, the patient reports dyspnea of effort for a few months. Which of the following antibiotics are indicated at this stage?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Levofloxacin","justification":""},{"idx":1,"correct":false,"proposition":"Amoxicillin","justification":""},{"idx":2,"correct":false,"proposition":"Metronidazole","justification":""},{"idx":3,"correct":false,"proposition":"Cefotaxime","justification":""},{"idx":4,"correct":false,"proposition":"Cotrimoxazole","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-3-qi-5","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" His condition improved after 7 days of amoxicillin. What do you foresee in the course of this episode?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Respiratory function tests","justification":""},{"idx":1,"correct":false,"proposition":"Allergological assessment","justification":""},{"idx":2,"correct":false,"proposition":"Lung scintigraphy","justification":""},{"idx":3,"correct":true,"proposition":"Pneumococcal vaccination","justification":""},{"idx":4,"correct":true,"proposition":"Annual influenza vaccination","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-3-qi-6","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" The patient is not seen again at the end of the episode. Six months after this first visit, he became unwell at home and was referred by his entourage to the emergency department. On clinical examination, the pulse is at 110 bpm, the temperature at 38.5 ° C, the blood pressure at 120\/70mmHg, the respiratory rate at 32 cycles \/ min with a saturation in ambient air of 91% initially. You mention pneumonia. Which clinical sign(s) would be in favor of this hypothesis?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"A hotbed of crackling","justification":""},{"idx":1,"correct":false,"proposition":"the presence of sibilants","justification":""},{"idx":2,"correct":false,"proposition":"decreased vocal vibration","justification":""},{"idx":3,"correct":false,"proposition":"A percussion tympanism","justification":""},{"idx":4,"correct":true,"proposition":"tubal murmur","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-3-qi-7","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" You have heard a focus of apical crackling upright. What is your assessment? (one or more correct answers)","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"venous Doppler of the lower limbs","justification":""},{"idx":1,"correct":false,"proposition":"a lung scan","justification":""},{"idx":2,"correct":true,"proposition":"chest x-ray","justification":""},{"idx":3,"correct":false,"proposition":"bronchial fibroscopy","justification":""},{"idx":4,"correct":false,"proposition":"bronchoalveolar lavage","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-3-qi-8","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" The chest X-ray is as follows: What is your interpretation?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Systematized impairment","justification":""},{"idx":1,"correct":false,"proposition":"Left upper lobar involvement","justification":""},{"idx":2,"correct":true,"proposition":"Alveolar syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Miliaria","justification":""},{"idx":4,"correct":false,"proposition":"Pneumothorax","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-3-qi-9","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" What biological assessment do you prescribe?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Blood platelet count","justification":""},{"idx":1,"correct":true,"proposition":"Blood ionogram - serum creatinine","justification":""},{"idx":2,"correct":true,"proposition":"Blood","justification":""},{"idx":3,"correct":false,"proposition":"Pneumococcal antigenemia","justification":""},{"idx":4,"correct":true,"proposition":"Cytobacteriological examination of sputum","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-3-qi-10","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" The laboratory assessment shows a biological inflammatory syndrome (CRP at 275 mg \/ L) with hyperleukocytosis. Biological kidney function is normal. Arterial lagazometrics is as follows: pH 7.48, PaO2 66 mmHg, PaCO 2 34 mmHg, HCO 3- 27 mmol \/ L.Regarding the cytobacteriological examination of sputum, which parameter(s) will encourage you to consider this examination as quality and reliable?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Monomicrobial character","justification":""},{"idx":1,"correct":false,"proposition":"Number of polynuclear units less than 25 per field","justification":""},{"idx":2,"correct":false,"proposition":"Number of bacterial colonies at 10 3 per m L","justification":""},{"idx":3,"correct":true,"proposition":"Number of epithelial cells less than 10 per field","justification":""},{"idx":4,"correct":false,"proposition":"Sampling in sputum medium","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-3-qi-11","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" Under 1 L\/min of nasal oxygen, saturation rises to 94% and respiratory rate drops to 22\/min. What is your attitude towards this patient? (one or more correct answers)","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Hospitalization in the medical department","justification":""},{"idx":1,"correct":false,"proposition":"Isolation \"air\"","justification":""},{"idx":2,"correct":false,"proposition":"Vancomycin treatment","justification":""},{"idx":3,"correct":false,"proposition":"Treatment with oseltamivir","justification":""},{"idx":4,"correct":false,"proposition":"Intravenous corticosteroid therapy","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-3-qi-12","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" A chest CT scan has been requested by your colleague on duty who also introduces treatment with amoxicillin-clavulanic acid. What is your interpretation of the image?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Alveolar condensation","justification":""},{"idx":1,"correct":false,"proposition":"Caves","justification":""},{"idx":2,"correct":false,"proposition":"Scissurite","justification":""},{"idx":3,"correct":false,"proposition":"Miliaria","justification":""},{"idx":4,"correct":true,"proposition":"Emphysema","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-3-qi-13","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" Two blood cultures are gram-positive diplococcus. Which antibiotic therapy(s) do you think are the most suitable at present?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Levofloxacin","justification":""},{"idx":1,"correct":false,"proposition":"Cefotaxime + spiramycin","justification":""},{"idx":2,"correct":false,"proposition":"Azithromycin","justification":""},{"idx":3,"correct":true,"proposition":"Amoxicillin","justification":""},{"idx":4,"correct":false,"proposition":"Amoxicillin + clavulanic acid","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-3-qi-14","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" Your patient's condition improves after 7 days of amoxicillin. As he goes home, he tells you that he worked for 30 years in insulation until his retirement, and handled a lot of asbestos. What pathology(s) can be related to this exposure to asbestos?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Pleural mesothelioma","justification":""},{"idx":1,"correct":false,"proposition":"Melanoma","justification":""},{"idx":2,"correct":true,"proposition":"Lung cancer","justification":""},{"idx":3,"correct":false,"proposition":"Ethmoid cancer","justification":""},{"idx":4,"correct":true,"proposition":"Asbestosis","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-3-qi-15","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" An objective control CT scan of bilateral non-calcified pleural plaques that had not been seen on the previous CT scan. Pleural plaques in a context of exposure to asbestos are the subject of an occupational disease table with a treatment period of 40 years. Can the patient claim recognition as an occupational disease?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"No, because he is retired","justification":""},{"idx":1,"correct":false,"proposition":"No because he smoked","justification":""},{"idx":2,"correct":false,"proposition":"No because it is ethyl","justification":""},{"idx":3,"correct":true,"proposition":"Yes because of the principle of presumption of origin","justification":""},{"idx":4,"correct":true,"proposition":"Yes because it does not exceed the support time","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-4-qi-1","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" What is (are) the semeiological data(s) to be specified at the interrogation that would direct you towards the diagnosis of arteriopathy obliterans of the lower limbs?","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"the occurrence of this pain when walking","justification":"This proposal was essential"},{"idx":1,"correct":false,"proposition":"The characteristics of this pain type of electric shocks s","justification":""},{"idx":2,"correct":false,"proposition":"the disappearance of pain at elevation of the lower limbs","justification":""},{"idx":3,"correct":false,"proposition":"the later onset of pain when walking on hills than when walking on flat ground","justification":""},{"idx":4,"correct":true,"proposition":"the onset of pain for a constant walking distance on flat ground","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-4-qi-2","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" In this patient, the pain occurs when walking, only in the lower right limb, for a fixed distance on flat ground that he estimates at 350 meters with a cramp type sitting at the calf. You notice the presence of a right iliac murmur and a murmur in the lower 1\/3 of the left thigh. Femoral pulses are perceived on both the right and the left. The left popliteal pulse is very easily found it appears ample, the right popliteal pulse is not perceived. In distality you perceive only the left posterior tibial pulse and the left pedinous pulse. On these data you evoke the presence of an obliterating arterial disease of the lower limbs. Which arterial lesion(s) do you suspect based on these clinical data?","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Right iliac stenosis","justification":""},{"idx":1,"correct":true,"proposition":"right femoral obliteration","justification":""},{"idx":2,"correct":false,"proposition":"obliteration of right leg arteries","justification":""},{"idx":3,"correct":true,"proposition":"Left femoral stenosis","justification":""},{"idx":4,"correct":true,"proposition":"Left popliteal aneurysm","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-4-qi-3","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" The clinical examination data led you to suspect the existence of right iliac stenosis, right femoral obliteration, left femoral stenosis and left popliteal aneurysm. What are the first two tests you need to order to confirm your diagnosis of peripheral arterial disease and to locate the arterial lesions you suspected?","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"arteriogram of the lower limbs","justification":""},{"idx":1,"correct":true,"proposition":"a measurement of ankle systolic pressure indexes","justification":""},{"idx":2,"correct":true,"proposition":"arterial Doppler ultrasound of the lower limbs","justification":""},{"idx":3,"correct":false,"proposition":"angiography of the lower limbs","justification":""},{"idx":4,"correct":false,"proposition":"MRI of the lower limbs","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-4-qi-4","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" The measurement of ankle pressure indexes confirmed the diagnosis of peripheral arterial disease obliterating the lower limbs (humeral systolic pressure at 166mmHg in the right arm and 162 mmHg in the left arm with systolic pressure in the right ankle at 114 mmHg: IPS at 0.69 on the right and systolic pressure in the left ankle at 132 mmHg:  IPS at 0.80 on the left). The Doppler ultrasound of the aorta and lower limbs shows: a normal aorta (antero-posterior diameter at 22 mm), a stenosis at 50% of the right external iliac artery, an obliteration of the right femoral artery with reinjection of the popliteal artery. The left femoral artery has a non-significant stenosis and the other arterial axes on the left are the site of diffuse atheromatous overload but without significant obstructive lesion. The left popliteal artery is not aneurysmal. The examination does not retain significant lesion of the leg arteries on the right or left. There is obliterating arterial disease of the lower extremities. What is the element that allows you to say that it is at the stage of exercise ischemia?","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"the value of the patient's estimated walking distance below the threshold of 500 meters","justification":""},{"idx":1,"correct":true,"proposition":"symptomatic character to intermittent claudication type","justification":""},{"idx":2,"correct":false,"proposition":"ankle systolic pressure greater than 50 mmHg","justification":""},{"idx":3,"correct":false,"proposition":"the value of the ankle pressure indexes less than 0.90","justification":""},{"idx":4,"correct":false,"proposition":"the existence of humeral anisotension","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-4-qi-5","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" In this symptomatic patient at the claudication stage, additional examinations objectified ankle systolic pressures greater than 50 mmHg and SNPIs <0.90 confirming the diagnosis of peripheral arterial disease of the lower limbs at the stage of exercise ischemia. There is no aneurysmal lesion, there is 50% right iliac stenosis and right femoral obliteration. The assessment of vascular risk factors in this former smoker did not find diabetes. What therapeutic strategies are possible at this stage? (one or more expected answers)","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"gait rehabilitation","justification":""},{"idx":1,"correct":false,"proposition":"Revascularization","justification":""},{"idx":2,"correct":true,"proposition":"Anti-aggregant treatment with aspirin","justification":""},{"idx":3,"correct":true,"proposition":"statin therapy","justification":""},{"idx":4,"correct":false,"proposition":"anticoagulant therapy","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-4-qi-6","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" The patient begins gait rehabilitation. He now receives atorvastatin, acetyl-salicylic acid, indapamide, fluoxetine and lercanidipine. He returned for consultation 3 months later. He performed a self-measurement cycle, the averaged values are 139\/64 mmHgThe blood pressure is measured at 160\/80 mmHg at the beginning of the consultation and then at 146\/60 mmHg symmetrically 15 minutes later. At this stage, what type(s) of high blood pressure can be suspected in this patient?","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Systolic hypertension","justification":""},{"idx":1,"correct":false,"proposition":"Resistant HTA","justification":""},{"idx":2,"correct":false,"proposition":"Masked HTA","justification":""},{"idx":3,"correct":false,"proposition":"Systolo-diastolic hypertension","justification":""},{"idx":4,"correct":false,"proposition":"HTA << white coat>>","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-4-qi-7","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" A biological assessment carried out before this visit shows: Na 130 mmol \/ L, K 3.4 mmol \/ L, serum creatinine 75 μmol \/ L. LDL cholesterol is 0.90 g \/ L.Among the treatments taken by the patient, which drug (s) can (can) explain the abnormalities of the ionogram?","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"indapamide","justification":""},{"idx":1,"correct":false,"proposition":"atorvastatin","justification":""},{"idx":2,"correct":true,"proposition":"fluoxetine","justification":""},{"idx":3,"correct":false,"proposition":"acetyl salicylic acid","justification":""},{"idx":4,"correct":false,"proposition":"lercanidipine","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-4-qi-8","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" Regarding the management of high blood pressure, what change(s) do you make to this patient's prescription?","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Indapamide judgment","justification":""},{"idx":1,"correct":false,"proposition":"Lercanidipine stop","justification":""},{"idx":2,"correct":false,"proposition":"Prescription of furosemide","justification":""},{"idx":3,"correct":true,"proposition":"prescription of an ACE inhibitor","justification":""},{"idx":4,"correct":false,"proposition":"Prescription of a beta-blocker","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-4-qi-9","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" You replace indapamide with an ACE inhibitor. In addition, what other measure(s) do you propose to this patient?","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"the prescription of potassium supplementation","justification":""},{"idx":1,"correct":false,"proposition":"the decrease in beverages to 0.75 liters per day","justification":""},{"idx":2,"correct":false,"proposition":"increased sodium intake","justification":""},{"idx":3,"correct":true,"proposition":"Annual flu vaccination","justification":""},{"idx":4,"correct":true,"proposition":"decreased alcohol consumption","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-4-qi-10","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" What is the most suitable test to evaluate the effectiveness of antihypertensive treatment in this patient? (only one exact answer)","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"resting electrocardiogram","justification":""},{"idx":1,"correct":true,"proposition":"Voltage self-measurement","justification":""},{"idx":2,"correct":false,"proposition":"echocardiography","justification":""},{"idx":3,"correct":false,"proposition":"24-hour voltage recording (MAPA)","justification":""},{"idx":4,"correct":false,"proposition":"24-hour electrocardiographic recording (Holter)","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-4-qi-11","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" What is (are) the expected benefit(s) of your care?","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"decreased risk of stroke","justification":""},{"idx":1,"correct":true,"proposition":"decreased risk of heart failure","justification":""},{"idx":2,"correct":false,"proposition":"decreased risk of aortic valve disease","justification":""},{"idx":3,"correct":true,"proposition":"decrease in cardiovascular mortality","justification":""},{"idx":4,"correct":false,"proposition":"Decreased thromboembolic venous risk","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-4-qi-12","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" The patient is currently being treated with ACE inhibitor and calcium channel blocker for antihypertensive purposes. Self-measurement shows an average blood pressure of 158\/72 mmHg.What are you looking for at the origin of this therapeutic ineffectiveness in this patient? (one or more correct answers)","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"fibromuscular dysplasia of the renal arteries","justification":""},{"idx":1,"correct":true,"proposition":"alcohol abuse","justification":""},{"idx":2,"correct":true,"proposition":"non-adherence","justification":""},{"idx":3,"correct":true,"proposition":"sleep apnea syndrome","justification":""},{"idx":4,"correct":true,"proposition":"improper use of the blood pressure self-measuring device","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-4-qi-13","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" Poor blood pressure control was linked to medication non-adherence. The patient received therapeutic education. During the first check-up visit to his general practitioner, the blood pressure self-measurement values are in the objectives. Biological abnormalities are normalized. You renew his treatment. What follow-up do you propose to this patient? (one or more correct answers)","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"annual echocardiography","justification":""},{"idx":1,"correct":false,"proposition":"a stress test every two years","justification":""},{"idx":2,"correct":false,"proposition":"a monthly consultation with the general practitioner","justification":""},{"idx":3,"correct":true,"proposition":"an annual blood ionogram","justification":""},{"idx":4,"correct":true,"proposition":"Blood pressure monitoring by self-measurement","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-5-qi-1","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" Here is the dermatological aspect of the patient. What semiological characteristics do you find on the 2 photos? (one or more correct answers)","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"èrythema","justification":""},{"idx":1,"correct":true,"proposition":"Papules","justification":""},{"idx":2,"correct":true,"proposition":"Dander","justification":""},{"idx":3,"correct":false,"proposition":"annular lesions","justification":""},{"idx":4,"correct":false,"proposition":"Vesicles","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-5-qi-2","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" From your semiological analysis and the history of this patient, which dermatological diagnosis seems to you to be the most likely? (only one response expected)","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Atopic dermatitis","justification":""},{"idx":1,"correct":false,"proposition":"maculopapular exanthema with bisoprolol","justification":""},{"idx":2,"correct":false,"proposition":"pityriasis rosé of Gibert","justification":""},{"idx":3,"correct":true,"proposition":"psoriasis","justification":""},{"idx":4,"correct":false,"proposition":"Mycosis fungoides","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-5-qi-3","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" You remember the diagnosis of psoriasis. How do you assess the intensity, severity and impact of it? (one or more correct answers)","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"PASI score","justification":""},{"idx":1,"correct":false,"proposition":"Genetic analysis for determination of susceptibility genes","justification":""},{"idx":2,"correct":true,"proposition":"dermatology life quality index (DLQI) score","justification":""},{"idx":3,"correct":false,"proposition":"rheumatoid factor test","justification":""},{"idx":4,"correct":true,"proposition":"radiography of the pelvis","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-5-qi-4","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" You suspect the association with psoriatic arthritis. What semiological and anamnestic elements would be in favor of this association? (one or more correct answers)","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"the existence of heel pain","justification":""},{"idx":1,"correct":true,"proposition":"nail damage","justification":""},{"idx":2,"correct":true,"proposition":"scalp involvement","justification":""},{"idx":3,"correct":false,"proposition":"high PASI score","justification":""},{"idx":4,"correct":false,"proposition":"Late onset in adulthood","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-5-qi-5","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" The PASI score is 22 (severe form) and the DLQI shows a profound alteration in the quality of life of this patient. At this stage, psoriatic arthritis is not confirmed. Blood ionogram, kidney function and liver function are normal. What are the treatment options available as a first-line treatment? (one or more correct answers)","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Local treatment with betamethasone and calcipotriol","justification":""},{"idx":1,"correct":true,"proposition":"UVB phototherapy","justification":""},{"idx":2,"correct":false,"proposition":"local treatment with vitamin D analogue","justification":""},{"idx":3,"correct":true,"proposition":"methotrexate","justification":""},{"idx":4,"correct":false,"proposition":"biotherapy","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-5-qi-6","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" The patient living in a rural area far from a phototherapy center, he asks you for an effective treatment because he is very affected by the extension of his dermatosis which confines him to his home. Which treatment do you prefer for this patient? (only one answer expected)","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Spa","justification":""},{"idx":1,"correct":false,"proposition":"hydroxychloroquine","justification":""},{"idx":2,"correct":true,"proposition":"methotrexate","justification":""},{"idx":3,"correct":false,"proposition":"cyclosporine","justification":""},{"idx":4,"correct":false,"proposition":"salazopyrin","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-5-qi-7","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" The patient's hypertension makes you prefer methotrexate to ciclosporin. You start treatment with 17.5 mg methotrexate weekly. You see the patient again after 3 months, the PASI score (Psoriasis Area and Severity Index) is 15, the heel pain is less intense but the patient still has hip pain for which he regularly takes NSAIDs. You are considering the use of biotherapy. What elements are part of your pre-therapeutic assessment? (one or more correct answers)","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"IGRA (quantiferon®) test","justification":""},{"idx":1,"correct":true,"proposition":"HIV testing serology","justification":""},{"idx":2,"correct":true,"proposition":"hepatitis B and C screening serologies","justification":""},{"idx":3,"correct":true,"proposition":"Verification of vaccinations","justification":""},{"idx":4,"correct":false,"proposition":"Thoraco-abdomino-pelvic CT scan","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-5-qi-8","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" What three biotherapies are you considering for this patient?","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Anti-CD20","justification":""},{"idx":1,"correct":true,"proposition":"Anti-IL-12\/IL-23","justification":""},{"idx":2,"correct":true,"proposition":"Anti-IL-17","justification":""},{"idx":3,"correct":true,"proposition":"Anti-TNFalpha","justification":""},{"idx":4,"correct":false,"proposition":"Anti-PD-1","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-5-qi-9","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" You have chosen to introduce an anti-IL17 biotherapy.What other elements should be considered in the management of psoriasis? (one or more correct answers)","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Dieting","justification":""},{"idx":1,"correct":true,"proposition":"Limiting alcohol intake","justification":""},{"idx":2,"correct":false,"proposition":"Valsartan stop","justification":""},{"idx":3,"correct":true,"proposition":"Bisoprolol replacement","justification":""},{"idx":4,"correct":true,"proposition":"seasonal influenza vaccination","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-5-qi-10","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" You see the patient again 1 year later, he followed your advice, lost 5 kgs. Psoriasis was greatly improved by an anti IL-17. As the prescription has not been renewed, the patient has not received any treatment for 4 months. He complains of persistent pain in his right foot (see photo). What diagnosis do you envisage for the involvement of the right big toe? (only one answer expected)","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"whitlow","justification":""},{"idx":1,"correct":false,"proposition":"Primary herpes infection","justification":""},{"idx":2,"correct":false,"proposition":"chronic candidosis dactylitis","justification":""},{"idx":3,"correct":true,"proposition":"onycho-pachydermo-periostitis","justification":""},{"idx":4,"correct":false,"proposition":"drop","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-5-qi-11","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" What test do you request in first line to confirm the diagnosis of onycho-pachydermo-periostitis? (only one answer expected)","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"X-ray of the feet","justification":""},{"idx":1,"correct":false,"proposition":"MRI right big toe","justification":""},{"idx":2,"correct":false,"proposition":"ultrasound of soft parts","justification":""},{"idx":3,"correct":false,"proposition":"rheumatoid factor test","justification":""},{"idx":4,"correct":false,"proposition":"CRP test","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-5-qi-12","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" The X-ray of the feet confirms your hypothesis. In association with the resumption of anti-IL-17, you have infiltrated cortisonic derivatives and prescribed non-steroidal anti-inflammatory drugs on demand. During a biological assessment to monitor the treatment, you find a high ferritinemia greater than 600 ng\/ml (N: 30-300). What is the most likely cause? (only one answer expected)","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Hereditary hemochromatosis","justification":""},{"idx":1,"correct":false,"proposition":"Psoriasis","justification":""},{"idx":2,"correct":true,"proposition":"Metabolic syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Beginning hepatic cirrhosis","justification":""},{"idx":4,"correct":false,"proposition":"Excessive meat consumption","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-5-qi-13","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" You consider that the metabolic syndrome that this patient presents is the most likely cause of this hyperferritinemia. What therapeutic measure(s) do you propose in the context of this patient?","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"low-calorie diet","justification":""},{"idx":1,"correct":true,"proposition":"Replacement of glibenclamide with metformin","justification":""},{"idx":2,"correct":false,"proposition":"Limiting daily dietary intake of iron to less than 5 mg\/d","justification":""},{"idx":3,"correct":false,"proposition":"bloodletting","justification":""},{"idx":4,"correct":false,"proposition":"treatment with deferoxamine","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-6-qi-1","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" For this patient, what information available makes you suspect sleep apnea syndrome? (one or more correct answers)","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Daytime sweating","justification":""},{"idx":1,"correct":true,"proposition":"Systemic arterial hypertension","justification":""},{"idx":2,"correct":true,"proposition":"Obesity","justification":""},{"idx":3,"correct":true,"proposition":"Nocturnal snoring","justification":""},{"idx":4,"correct":true,"proposition":"Decreased libido","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-6-qi-2","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" You perform a nocturnal polygraph that targets a hypopnea apnea index of 55\/h and confirms severe obstructive sleep apnea syndrome. What treatments do you offer as a first-line treatment? (one or more correct answers)","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Bariatric surgery","justification":""},{"idx":1,"correct":false,"proposition":"Inhaled bronchodilators","justification":""},{"idx":2,"correct":true,"proposition":"Continuous positive airway pressure","justification":""},{"idx":3,"correct":true,"proposition":"Hygiene-dietary rules","justification":""},{"idx":4,"correct":false,"proposition":"Pulmonary rehabilitation","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-6-qi-3","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" As part of his profession as a bus driver, what measures do you recommend? (one or more correct answers)","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"A work stoppage at the beginning of the care","justification":""},{"idx":1,"correct":false,"proposition":"Outplacement","justification":""},{"idx":2,"correct":true,"proposition":"A wakefulness maintenance test after 1 month of well-conducted treatment","justification":""},{"idx":3,"correct":false,"proposition":"Information about his sleep apnea from his employer","justification":""},{"idx":4,"correct":false,"proposition":"Stopping amlodipine","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-6-qi-4","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" Despite the appropriate and effective management of sleep apnea syndrome for several months, your patient's wife sees no improvement in their sex life. What clinical elements would point to the existence of hypogonadism in this patient? (one or more correct answers)","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Baldness","justification":""},{"idx":1,"correct":true,"proposition":"Gynecomastia","justification":""},{"idx":2,"correct":false,"proposition":"An enlarged prostate","justification":""},{"idx":3,"correct":true,"proposition":"The absence of morning erection","justification":""},{"idx":4,"correct":false,"proposition":"Night cramps","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-6-qi-5","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" Testicular palpation reveals small testicles, he has gynecomastia and states that he does not have a morning erection. You strongly suspect acquired male hypogonadism. Which biological examination, for diagnostic purposes, is the most relevant at this stage? (only one answer expected)","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Total testosteronemia","justification":""},{"idx":1,"correct":false,"proposition":"PSA assay","justification":""},{"idx":2,"correct":false,"proposition":"Prolactin dosage","justification":""},{"idx":3,"correct":false,"proposition":"cortisol at 8am","justification":""},{"idx":4,"correct":false,"proposition":"spermogram and spermocytogram","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-6-qi-6","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" You prescribe a total testosterone assay performed one morning on an empty stomach whose result is: 1.2 ng \/ mL (N: 4-10). What are the two tests that you must imperatively prescribe to advance in your diagnostic process?","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"LH","justification":""},{"idx":1,"correct":false,"proposition":"Free testosterone","justification":""},{"idx":2,"correct":true,"proposition":"Prolactin","justification":""},{"idx":3,"correct":false,"proposition":"Sulfate de DHEA","justification":""},{"idx":4,"correct":false,"proposition":"hCG","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-6-qi-7","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" Here are the results of this assessment: LH 3.3 IU\/L ( N: 2.1 - 6.3); prolactin 54 μg\/L (N < 20). At this stage, what is the most relevant imaging test? (only one answer expected)","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"MRI of the hypothalamic-pituitary region","justification":""},{"idx":1,"correct":false,"proposition":"Testicular ultrasound","justification":""},{"idx":2,"correct":false,"proposition":"Prostatic ultrasound","justification":""},{"idx":3,"correct":false,"proposition":"Abdominopelvic CT scan","justification":""},{"idx":4,"correct":false,"proposition":"Thyroid ultrasound","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-6-qi-8","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" You request an MRI of the hypothalamic-pituitary region, a section of which is shown below. Which of the following are true? (one or more correct answers)","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"This is a coronal cup","justification":""},{"idx":1,"correct":false,"proposition":"This is a sequence in T2","justification":""},{"idx":2,"correct":true,"proposition":"There is pituitary adenoma","justification":""},{"idx":3,"correct":false,"proposition":"The arrow indicates the hypothalamus","justification":""},{"idx":4,"correct":false,"proposition":"There is an attack of the optic chiasma","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-6-qi-9","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" Among the elements at your disposal, which can guide you towards the diagnosis of acromegaly in this patient? (one or more correct answers)","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"High blood pressure","justification":""},{"idx":1,"correct":true,"proposition":"Sleep apnea syndrome","justification":""},{"idx":2,"correct":false,"proposition":"Obesity","justification":""},{"idx":3,"correct":false,"proposition":"Low libido","justification":""},{"idx":4,"correct":true,"proposition":"Excessive sweating","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-6-qi-10","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" You recover the IGF1 test that you requested as part of the pituitary assessment. It returns moderately increased for the age of the patient. In order to establish your diagnosis of acromegaly, you perform oral induced hyperglycemia (OPGH) with 75 grams of glucose whose results are as follows:","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Changes in GH testing during OPGH are sufficient to confirm the diagnosis of acromegaly","justification":""},{"idx":1,"correct":false,"proposition":"Concomitant testing of IGF1 and GH is necessary to diagnose acromegaly","justification":""},{"idx":2,"correct":false,"proposition":"Diagnosis of acromegaly is based on concomitant blood glucose and GH testing during OPGH","justification":""},{"idx":3,"correct":false,"proposition":"Concomitant insulin and GH testing is necessary to diagnose acromegaly","justification":""},{"idx":4,"correct":false,"proposition":"The concomitant discovery of diabetes mellitus prevents the interpretation of the GH assay","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-6-qi-11","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" You have been diagnosed with acromegaly and diabetes mellitus. He was cared for and considered cured of his acromegaly. His diabetes persists. Among the following biological results, what would be the two elements expected in the context of type 2 diabetes of recent discovery?","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Triglycerides at 2.40 g\/L (N: 0.6 - 1.6)","justification":""},{"idx":1,"correct":false,"proposition":"HDL-C at 0.68 g\/L (N > 0.35)","justification":""},{"idx":2,"correct":false,"proposition":"LDL-C at 1.85 g\/L (N: 0.6 - 1.6)","justification":""},{"idx":3,"correct":false,"proposition":"AST at 85 IU\/L (N < 35) and ALT at 35 IU\/L (N < 40)","justification":""},{"idx":4,"correct":true,"proposition":"HbA1c at 8.5% (N < 7%)","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-6-qi-12","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" Metformin was introduced about one year after diagnosis. HbA1c is now at 7.3%, with late morning blood glucose levels at 2.30 g\/L. His current BMI is 28.5 kg\/m 2.Which of the following treatment options do you think is the most relevant?","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Adding a rapid-acting insulin injection before breakfast","justification":""},{"idx":1,"correct":true,"proposition":"Addition of sitagliptin","justification":"This question was a single answer, as indicated in the statement"},{"idx":2,"correct":false,"proposition":"Addition of acarbose","justification":""},{"idx":3,"correct":false,"proposition":"Addition of an analogue of GLP1","justification":""},{"idx":4,"correct":false,"proposition":"Adding a slow insulin injection at bedtime","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-6-qi-13","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" His treatment was intensified by the addition of sitagliptin. Which of the following elements from his medical history constitute an issue in order to validate or not his fitness to drive buses?","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Metformin treatment","justification":""},{"idx":1,"correct":false,"proposition":"treatment of high blood pressure","justification":""},{"idx":2,"correct":false,"proposition":"History of acromegaly","justification":""},{"idx":3,"correct":false,"proposition":"Treatment with sitagliptin","justification":""},{"idx":4,"correct":true,"proposition":"sleep apnea syndrome","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-6-qi-14","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" He complains of edema of the lower limbs which he attributes to amlodipine. He wants to stop this treatment. What therapeutic classes can be indicated for him in first line? (one or more correct answers)","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"central antihypertensive drug","justification":""},{"idx":1,"correct":true,"proposition":"ACE inhibitor","justification":""},{"idx":2,"correct":true,"proposition":"Sartan","justification":""},{"idx":3,"correct":false,"proposition":"beta-blocker","justification":""},{"idx":4,"correct":false,"proposition":"thiazide diuretic","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-7-qi-1","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" What measures do you take in the emergency room, when the patient is admitted? (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"intravenous analgesic","justification":""},{"idx":1,"correct":false,"proposition":"Treatment with vasopressive amines","justification":""},{"idx":2,"correct":false,"proposition":"placement of a urinary catheter","justification":""},{"idx":3,"correct":true,"proposition":"nasogastric tube placement","justification":""},{"idx":4,"correct":true,"proposition":"vascular filling","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-7-qi-2","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" Regarding the abdominal contracture of this patient, what are the exact proposals? (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"there is peritoneal irritation","justification":""},{"idx":1,"correct":true,"proposition":"It's a surgical emergency","justification":""},{"idx":2,"correct":false,"proposition":"  It may be related to significant desydratation","justification":""},{"idx":3,"correct":true,"proposition":"it is invincible on palpation","justification":""},{"idx":4,"correct":false,"proposition":"it is voluntary, in reaction to abdominal palpation","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-7-qi-3","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" What diagnoses do you mention at this stage? (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"a perforated ulcer","justification":""},{"idx":1,"correct":true,"proposition":"diverticular perforated peritonitis","justification":""},{"idx":2,"correct":false,"proposition":"hepatic colic","justification":""},{"idx":3,"correct":false,"proposition":"acute pyelonephritis","justification":""},{"idx":4,"correct":true,"proposition":"appendicular peritonitis","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-7-qi-4","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" What biological tests do you prescribe urgently? (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"blood type and search for irregular agglutinins","justification":""},{"idx":1,"correct":false,"proposition":"serology Helicobacter pylori","justification":""},{"idx":2,"correct":true,"proposition":"Blood","justification":""},{"idx":3,"correct":true,"proposition":"serum creatinine","justification":""},{"idx":4,"correct":true,"proposition":"TP and TCA","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-7-qi-5","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" What additional examination do you request to establish your etiological diagnosis? (only one answer expected)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Abdominopelvic ultrasound","justification":""},{"idx":1,"correct":false,"proposition":"X-ray of the abdomen without preparation","justification":""},{"idx":2,"correct":true,"proposition":"Abdomino-pelvic CT scan","justification":""},{"idx":3,"correct":false,"proposition":"Gastro-duodenal fibroscopy","justification":""},{"idx":4,"correct":false,"proposition":"chest X-ray","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-7-qi-6","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" Here are some scannographic sections:What are the exact proposals? (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"it is an abdominopelvic scan in axial section (transverse)","justification":""},{"idx":1,"correct":false,"proposition":"the number 1 corresponds to the uterus","justification":""},{"idx":2,"correct":true,"proposition":"the number 2 corresponds to an effusion in Douglas' cul de sac","justification":""},{"idx":3,"correct":true,"proposition":"The number 3 corresponds to an appendicular stercolith","justification":""},{"idx":4,"correct":false,"proposition":"The right kidney is visible in one of these pictures","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-7-qi-7","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" About this scannographic section:What are the exact proposals? (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"the aorta is visible","justification":""},{"idx":1,"correct":false,"proposition":"there is a pneumoperitoneum","justification":""},{"idx":2,"correct":false,"proposition":"the number 4 corresponds to the left kidney","justification":""},{"idx":3,"correct":true,"proposition":"  The number 5 corresponds to a fluid effusion","justification":""},{"idx":4,"correct":false,"proposition":"There is a cluster of slender loops","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-7-qi-8","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" About digestive vascular anatomy, what are the exact answers? (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"the celiac trunk gives rise to the left gastric artery, the common hepatic artery and the splenic artery","justification":""},{"idx":1,"correct":true,"proposition":"the Riolan arch is an anastomosis between the upper and lower mesenteric territory","justification":""},{"idx":2,"correct":true,"proposition":"The appendix is vascularized by an arterial branch from the superior mesenteric artery","justification":""},{"idx":3,"correct":false,"proposition":"the right colon is vascularized by the inferior mesenteric artery","justification":""},{"idx":4,"correct":false,"proposition":"The inferior mesenteric vein drains into the inferior vena cava","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-7-qi-9","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" You are diagnosed with acute generalized peritonitis of appendicular origin. What are the main principles of management of this pathology? (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"The surgery may be postponed for a few hours under the guise of antibiotic therapy","justification":""},{"idx":1,"correct":true,"proposition":"At this stage, intravenous broad-spectrum antibiotic therapy should be prescribed.","justification":""},{"idx":2,"correct":true,"proposition":"A peritoneal toilet with saline will be systematically performed","justification":""},{"idx":3,"correct":false,"proposition":"An appendectomy and resection of the cecum more or less extensive to the ascending colon must be performed","justification":""},{"idx":4,"correct":true,"proposition":"The appendix is systematically sent to the Anatomical Pathology Laboratory","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-7-qi-10","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" The patient receives an emergency appendectomy with peritoneal toilet. She has a postoperative antibiotic therapy for 5 days paramoxicillin-clavulanic acid, adapted to the identification of a multisensitive Escherichia coli isolated in samples taken intraoperatively. The postoperative follow-up is simple. Discharge is allowed on the 6th postoperative day. The patient is urgently readmitted 48 hours later for hyperthermia at 38.5 ° C associated with abdominal pain. The digital rectal examination objective a painful pelvic mass. What is the most likely diagnosis? (only one answer expected)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"pyelonephritis","justification":""},{"idx":1,"correct":true,"proposition":"a Douglassian abscess","justification":""},{"idx":2,"correct":false,"proposition":"phlebitis of the ovarian vein","justification":""},{"idx":3,"correct":false,"proposition":"a wall abscess","justification":""},{"idx":4,"correct":false,"proposition":"ulcer perforation","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-7-qi-11","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" The patient quickly benefits from an abdominopelvic CT scan confirming the diagnosis of abscesses at the pelvic level, measured at 6 cm. (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"  there is no need to hospitalize the patient","justification":""},{"idx":1,"correct":true,"proposition":"drainage is required to drain the abscess","justification":""},{"idx":2,"correct":true,"proposition":"a bacteriological sample of the contents of the abscess must be taken","justification":""},{"idx":3,"correct":true,"proposition":"  Percutaneous radio-guided drainage is possible","justification":""},{"idx":4,"correct":false,"proposition":"Antibiotic therapy with amoxicillin-clavulanic acid should be resumed","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-7-qi-12","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" The patient is hospitalized. The abscess is drained under CT control. Antibiotic therapy is adapted to bacteriological samples taken during drainage. There is no need to reoperate the patient. Six months later, she consults for the appearance of an umbilical swelling, appeared at the level of an incision scar. What signs point to uncomplicated eventration? (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"swelling is expandable to cough","justification":""},{"idx":1,"correct":false,"proposition":"swelling is inflammatory","justification":""},{"idx":2,"correct":false,"proposition":"swelling is irregular","justification":""},{"idx":3,"correct":true,"proposition":"swelling is reducible","justification":""},{"idx":4,"correct":false,"proposition":"swelling is painful","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-7-qi-13","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" The patient asks you about this eventration, what can you tell her? (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"The risk of strangulation increases with the size of the collar","justification":""},{"idx":1,"correct":true,"proposition":"An intervention can be scheduled to close the parietal defect","justification":""},{"idx":2,"correct":false,"proposition":"spontaneous closure is still possible","justification":""},{"idx":3,"correct":true,"proposition":"ventration may increase in size over time","justification":""},{"idx":4,"correct":true,"proposition":"  An intervention prevents the risk of strangulation","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-7-qi-14","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" The patient prefers not to consider intervention. Five years later, she was referred to the emergency room for a sudden abdominal pain syndrome, associated with vomiting and stopping gas. On clinical examination, the abdomen is weathered, sensitive as a whole. The umbilical ventration has increased in volume, it is reducible. What is the most likely diagnosis? (only one answer expected)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Flanged occlusion","justification":""},{"idx":1,"correct":false,"proposition":"Recurrent appendicitis on stump","justification":""},{"idx":2,"correct":false,"proposition":"Recurrent peritonitis on appendicular stump release","justification":""},{"idx":3,"correct":false,"proposition":"Strangulation on ventration","justification":""},{"idx":4,"correct":false,"proposition":"hepatic colic","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-7-qi-15","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" The patient is operated urgently for a flange occlusion. It is not necessary to do digestive resection and the postoperative follow-up is simple. What information can you give to the patient post-operatively? (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"A new occlusion is no longer to be feared because the flange has been severed","justification":""},{"idx":1,"correct":true,"proposition":"Eventration can still occur on the scars of this procedure","justification":""},{"idx":2,"correct":true,"proposition":"Low molecular weight heparin at a prophylactic dose is indicated postoperatively","justification":""},{"idx":3,"correct":false,"proposition":"Rapid resumption of oral feeding is possible with a residue-free diet during the 20 post-operative days","justification":""},{"idx":4,"correct":true,"proposition":" The resumption of transit is favored by the rapid resumption of physical activity","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-8-qi-1","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" With the elements of pulmonary auscultation that you have, what are the two most likely diagnostic hypotheses?","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"neuromuscular diseases","justification":""},{"idx":1,"correct":true,"proposition":"left heart failure","justification":""},{"idx":2,"correct":false,"proposition":"diffuse interstitial lung disease","justification":""},{"idx":3,"correct":false,"proposition":"asthma","justification":""},{"idx":4,"correct":true,"proposition":"chronic obstructive pulmonary disease (COPD)","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-8-qi-2","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" In the context of this chronic dyspnea, which additional examination(s) do you request in first line?","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"X-ray of standing chest","justification":""},{"idx":1,"correct":false,"proposition":"Chest CT angiography with pulmonary arterial time","justification":""},{"idx":2,"correct":false,"proposition":"D-Dimers","justification":""},{"idx":3,"correct":false,"proposition":"PET scanner","justification":""},{"idx":4,"correct":false,"proposition":"CRP","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-8-qi-3","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":"    CBC is normal. The chest x-ray requested is below.   As part of the assessment of this chronic dyspnea, you perform the following examination:","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"There is a disorder in the diffusion of carbon monoxide","justification":""},{"idx":1,"correct":false,"proposition":"there is reversibility of FEV1 after taking beta2 mimetics","justification":""},{"idx":2,"correct":false,"proposition":"The exam, to be interpretable, requires smoking cessation for at least two days.","justification":""},{"idx":3,"correct":false,"proposition":"the FEV1\/FVC ratio is not interpretable","justification":""},{"idx":4,"correct":true,"proposition":"there is chest distension","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-8-qi-4","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" You associate, in a second step, a plethysmography to the volume flow loop previously realized. What is (are) the additional information(s) provided by this review?","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"There is a disorder in the diffusion of carbon monoxide","justification":""},{"idx":1,"correct":true,"proposition":"It makes it possible to measure non-mobilizable lung volumes","justification":""},{"idx":2,"correct":true,"proposition":"total lung capacity is significantly increased","justification":""},{"idx":3,"correct":true,"proposition":"the residual volume is significantly increased","justification":""},{"idx":4,"correct":true,"proposition":"You can say that there is no restrictive syndrome","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-8-qi-5","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" In addition, to complete the EFRs, a carbon monoxide diffusion test (DLCO) was performed. It is 55% theoretical. Based on all the elements you now have available, what diagnosis(s) do you remember?","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"asthma","justification":""},{"idx":1,"correct":false,"proposition":"chronic bronchitis","justification":""},{"idx":2,"correct":true,"proposition":"chronic obstructive pulmonary disease (COPD)","justification":""},{"idx":3,"correct":false,"proposition":"amyotrophic lateral sclerosis","justification":""},{"idx":4,"correct":false,"proposition":"Hyperventilation syndrome","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-8-qi-6","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" This patient therefore suffers from COPD. What therapeutic strategy(s) can you implement at this stage as background treatment?","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"home nebulizations of short-acting beta2 mimetics","justification":"This proposal is unacceptable"},{"idx":1,"correct":true,"proposition":"inhaled treatment with a long-acting bronchodilator","justification":""},{"idx":2,"correct":false,"proposition":"inhaled therapy with a combination of two inhaled long-acting bronchodilators","justification":""},{"idx":3,"correct":false,"proposition":"inhaled therapy with a fixed combination of inhaled corticosteroid and long-acting beta2 mimetic","justification":"This proposal is also unacceptable."},{"idx":4,"correct":false,"proposition":"oral corticosteroids of 1 mg\/kg for 15 days before new EFRs","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-8-qi-7","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" Another essential step in its management is to consider quitting smoking as soon as possible. The patient seems motivated and asks you about nicotine substitutes. Regarding these nicotine substitutes, which is (are) the right answer(s)?","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"None of these nicotine substitutes are covered by health insurance","justification":""},{"idx":1,"correct":false,"proposition":"A cardiological assessment must be carried out prior to prescription","justification":""},{"idx":2,"correct":true,"proposition":"they have few side effects at recommended doses","justification":""},{"idx":3,"correct":true,"proposition":"their dosage must be adapted to the consumption of cigarettes","justification":""},{"idx":4,"correct":false,"proposition":"Only the cutaneous form by patch is effective","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-8-qi-8","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" The patient also described during questioning daytime asthenia responsible for a lack of enthusiasm and drowsiness that she considered normal. You mention the possibility of sleep apnea syndrome. The patient does not know if she is snoring. What signs do you look for besides daytime sleepiness to get arguments in favor of diagnosing sleep apnea syndrome? Give the answer(s) right.","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Uncontrollable cravings during the day","justification":""},{"idx":1,"correct":true,"proposition":"morning headaches","justification":""},{"idx":2,"correct":true,"proposition":"feelings of suffocation during sleep","justification":""},{"idx":3,"correct":true,"proposition":"difficulty concentrating","justification":""},{"idx":4,"correct":true,"proposition":"nocturnal polyuria","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-8-qi-9","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" You decide to make a ventilatory polygraph recording of which you have attached an extract of its nocturnal trace. What is (are) the exact answer(s)?","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"  This trace shows obstructive sleep apnea","justification":""},{"idx":1,"correct":false,"proposition":"This examination also includes an electroencephalogram","justification":""},{"idx":2,"correct":true,"proposition":"Oxygen saturation varies during this recording","justification":""},{"idx":3,"correct":false,"proposition":"This trace shows central sleep apnea","justification":""},{"idx":4,"correct":true,"proposition":"This plot shows that the thoraco-abdominal movements are in phase opposition during the phases of cessation of nasal flow","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-8-qi-10","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" After complete analysis of this recording, you were able to calculate a hypopnea apnea index greater than 60\/h. Give the right answer.","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"the patient is not obese, so you do not remember the diagnosis of obstructive sleep apnea syndrome","justification":""},{"idx":1,"correct":true,"proposition":"you are considering the installation of a continuous positive airway pressure device","justification":""},{"idx":2,"correct":false,"proposition":"you are considering hygiene measures alone for three months before a new inspection","justification":""},{"idx":3,"correct":false,"proposition":"you are considering a diuretic test before a new control at one month","justification":""},{"idx":4,"correct":false,"proposition":"you prescribe low doses of benzodiazepines","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-8-qi-11","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" She had recently benefited from a chest CT scan that she shows you. This confirms the predominant emphysema lesions at the top. This scanner also makes it possible to discover a nodule measured at 6 mm in its largest axis at the level of the lower left lobe (arrow). What are the criteria in favor of the benign nature of this nodule? Give the right answer(s)","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"its size","justification":""},{"idx":1,"correct":true,"proposition":"its regular contour","justification":""},{"idx":2,"correct":false,"proposition":"the patient's smoking","justification":""},{"idx":3,"correct":false,"proposition":"the diagnosis of COPD in this patient","justification":""},{"idx":4,"correct":false,"proposition":"the absence of calcification in its center","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-8-qi-12","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" Regarding the management of this nodule, what will you propose? (one or more correct answers)","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"positron emission tomography","justification":""},{"idx":1,"correct":false,"proposition":"a biopsy under CT scan","justification":""},{"idx":2,"correct":true,"proposition":"A scanner check in several months","justification":""},{"idx":3,"correct":false,"proposition":"an interferon release test even in the absence of tuberculosis contagion","justification":""},{"idx":4,"correct":false,"proposition":"Excision surgery from the outset","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-8-qi-13","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" A follow-up by control scanner was carried out. This monitoring is reassuring without any evolution of the nodule. Two years after initial management, the patient uses her continuous positive airway pressure (CPAP) machine very regularly and has benefited greatly symptomatically. His dyspnea is improved by taking a long-acting beta2-mimetic. She still pursues a smoking of the order of 5 cigarettes \/ day. She has no other comorbidities and is not taking any other treatment. Its EFRs are stable. You lose sight of it. She comes back to see you in consultation four years later because for about 3 days she has a worsening of her respiratory symptoms with an increase in dyspnea and the appearance of dirty sputum while she had no sputum before. Pulmonary auscultation findbilateral ronchi. The respiratory rate is 12\/min at rest. Air saturation is 96% at rest, there are no signs of respiratory distress. You prescribe appropriate antibiotic therapy. What other treatment(s) is (are) justified in the management of this COPD exacerbation? ","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"short-acting beta2 agonists","justification":"This proposal is essential"},{"idx":1,"correct":false,"proposition":"inhaled corticosteroids","justification":""},{"idx":2,"correct":false,"proposition":"home oxygen therapy to be re-evaluated in one month","justification":""},{"idx":3,"correct":false,"proposition":"oral corticosteroid therapy of 1 mg\/kg per day for 15 days","justification":"This proposal is unacceptable"},{"idx":4,"correct":false,"proposition":"non-invasive ventilation (NIV)","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-8-qi-14","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" It improves and returns to its basic state thanks to your treatment. In the following year she experienced at least two more similar episodes of COPD exacerbation. Her dyspnea is stage I of MRCD. To adapt his background treatment, what do you prescribe? Give the right answer(s)","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"inhaled therapy with a combination of two inhaled long-acting bronchodilators","justification":""},{"idx":1,"correct":true,"proposition":"inhaled therapy with a fixed combination of an inhaled corticosteroid and a long-acting beta2","justification":""},{"idx":2,"correct":false,"proposition":"inhaled therapy with a combination of two long-acting bronchodilators and an inhaled corticosteroid","justification":""},{"idx":3,"correct":false,"proposition":"oral corticosteroid therapy of 0.5 mg\/kg for one month before new EFRs","justification":""},{"idx":4,"correct":true,"proposition":"pulmonary rehabilitation","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-8-qi-15","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" You want the patient to undertake pulmonary rehabilitation. You have also prescribed inhaled treatment with a combination of an inhaled corticosteroid and a long-acting beta2-mimetic. What side effects are common with this type of inhaled treatment? Give the right answer(s)","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"dysphonia","justification":""},{"idx":1,"correct":true,"proposition":"Oral mycosis","justification":""},{"idx":2,"correct":false,"proposition":"peptic ulcer","justification":""},{"idx":3,"correct":true,"proposition":"tremors","justification":""},{"idx":4,"correct":false,"proposition":"systemic hypertension","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-8-qi-16","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" The patient continued to smoke for another two years and eventually stopped. She is 75 years old. Unfortunately very gradually his respiratory condition worsened and dyspnea only progressed. She is now dyspneic for moderate efforts of daily life. She had not wanted to do pulmonary rehabilitation. She has not had a new exacerbation for at least a year. You produce arterial blood gases at rest: pH 7.40; PaO 2 54 mmHg; PaCO2 42 mmHg; bicarbonates 26 mmol \/ l.Blood gases made three weeks apart under the same conditions are identical. She always puts on her CPAP well. You have achieved a nocturnal saturation that shows a regular pattern but a low saturation of the order of 89% all night. What can you conclude from the data you have available? Give the correct answer(s).","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"It's too late to consider pulmonary rehabilitation","justification":""},{"idx":1,"correct":false,"proposition":"It will be necessary to make a blood gas while she sleeps","justification":""},{"idx":2,"correct":false,"proposition":"It will be necessary to replace CPAP with nocturnal oxygen therapy","justification":""},{"idx":3,"correct":false,"proposition":"The patient is on an indication for ambulation oxygen therapy only","justification":""},{"idx":4,"correct":true,"proposition":"The patient is undergoing long-term oxygen therapy","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-8-qi-17","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" The patient is undergoing long-term oxygen therapy. This will be implemented alone during the day and associated with CPAP at night. Give the correct answer(s) regarding long-term oxygen therapy.","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Its main purpose is to avoid the occurrence of right heart failure","justification":""},{"idx":1,"correct":true,"proposition":"It must be at least 15 hours out of 24","justification":""},{"idx":2,"correct":false,"proposition":"it will impose the institutionalization of the patient given her age","justification":""},{"idx":3,"correct":true,"proposition":"it will be necessary to ensure, during its implementation, that PaCO 2 remains stable","justification":""},{"idx":4,"correct":false,"proposition":"It is not covered by health insurance","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-9-qi-1","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" What can you conclude from these clinical elements? (one or more possible answers)","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"The clinical picture suggests polyarthritis","justification":""},{"idx":1,"correct":true,"proposition":"He has asthenia","justification":""},{"idx":2,"correct":true,"proposition":"The interrogation of his wife can provide elements of etiological orientation","justification":""},{"idx":3,"correct":true,"proposition":"the clinical picture is compatible with a depressive syndrome","justification":""},{"idx":4,"correct":true,"proposition":"An associated weight loss should be sought","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-9-qi-2","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" The weight in consultation is 68 kg. He announces a usual weight of 70 kg, relatively stable in recent years, and he has not recently changed his eating habits. It is 1.75 m tall. The body mass index (BMI) is 22.2 kg\/m2. Which proposal(s) is (are) the exact proposal(s)?","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"his weight loss corresponds to the definition of voluntary weight loss","justification":""},{"idx":1,"correct":false,"proposition":"his BMI corresponds to a phenotypic criterion of undernutrition","justification":""},{"idx":2,"correct":true,"proposition":"the presence of tachycardia would constitute an element of orientation","justification":""},{"idx":3,"correct":true,"proposition":"A sadness of mood must be sought","justification":""},{"idx":4,"correct":true,"proposition":"the existence of associated diarrhoea is a discriminating element of interrogation","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-9-qi-3","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" There is no mood sadness, or anything else in favor of a depressive syndrome. However, there has been a decrease in libido for several months. What question(s) should you ask to look for hypogonadism?","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"depilation","justification":""},{"idx":1,"correct":false,"proposition":"dysuria","justification":""},{"idx":2,"correct":true,"proposition":"erectile dysfunction","justification":""},{"idx":3,"correct":true,"proposition":"gynecomastia","justification":""},{"idx":4,"correct":false,"proposition":"increased muscle mass","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-9-qi-4","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" Mr. R. has erectile dysfunction, depilation, predominant in the lower limbs, as well as a diffuse brown coloration, especially of the face, neck, back of the hands, forearms, and oral mucosa. What biological abnormality(s) can be associated with the abnormal skin coloration observed in this patient?","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"low 8-hour cortisol level with high 8-hour plasma ACTH assay","justification":""},{"idx":1,"correct":false,"proposition":"increased 24-hour cortisoluria with low plasma ACTH assay","justification":""},{"idx":2,"correct":false,"proposition":"hypercalcemia with increased PTH","justification":""},{"idx":3,"correct":true,"proposition":"elevated transferrin saturation coefficient (TSC) with increased ferritin","justification":""},{"idx":4,"correct":false,"proposition":"Tricytopenia with increased erythropoietin","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-9-qi-5","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" The examination reveals a firm hepatomegaly at 2 finger crossings. The spleen is not palpable. You do not notice jaundice or stellar angioma. There is no abdominal collateral venous circulation. Abdominal percussion does not show dullness declivated. There is no palpable lymphadenopathy. Mr. R. consumes 3 glasses of red wine at the evening meal. What interpretation(s) can you make of this clinical picture? (one or more possible answers)","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"absence of signs of portal hypertension excludes hepatic cirrhosis","justification":""},{"idx":1,"correct":false,"proposition":"absence of signs of hepatocellular insufficiency excludes hepatic cirrhosis","justification":""},{"idx":2,"correct":true,"proposition":"It is necessary to look for hepatojugular reflux","justification":""},{"idx":3,"correct":false,"proposition":"the patient's BMI points to metabolic syndrome","justification":""},{"idx":4,"correct":false,"proposition":"The patient's daily consumption of pure alcohol is 15 grams per day","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-9-qi-6","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" The analyses show: ALT 105 IU\/L (normal: 8-35), AST 55 IU\/L (normal: 6-25), gamma-glutamyl-transpeptidase 60 IU\/L (normal < 40), alkaline phosphatase 173 IU\/L (normal: 35-105), TP 65%. The blood count is normal. A liver ultrasound shows hepatomegaly with hypertrophy of the left lobe and hepatic dysmorphism with heterogeneous parenchyma and irregularity of the hepatic contours (bumpy appearance). Absence of portal flow reversal or splenomegaly. Which exam(s) are you requesting?","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"hepatitis B serology","justification":""},{"idx":1,"correct":true,"proposition":"transferrin saturation coefficient","justification":""},{"idx":2,"correct":false,"proposition":"Anti-cytoplasmic antibodies of neutrophils","justification":""},{"idx":3,"correct":true,"proposition":"hepatitis C serology","justification":""},{"idx":4,"correct":true,"proposition":"anti-smooth muscle antibodies (anti-LKM1)","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-9-qi-7","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" In this patient, who most likely has cirrhosis, the biological assessment reveals: transferrin saturation coefficient 80%, ferritin 2450 μg \/ L, search for anti-HCV antibodies negative, HBs antigen: negative, anti-HBs antibodies: positive with rate at 100 IU \/ L, anti-HBc antibody: negative. Against this background, you also prescribe serum protein electrophoresis. What is your interpretation of this electrophoresis? (one or more correct answers) ","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"polyclonal hypergammaglobulinemia","justification":""},{"idx":1,"correct":false,"proposition":"monoclonal gammopathy","justification":""},{"idx":2,"correct":false,"proposition":"hyper-alpha2-globulinemia","justification":""},{"idx":3,"correct":true,"proposition":"beta-gamma block","justification":""},{"idx":4,"correct":true,"proposition":"hypoalbuminemia","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-9-qi-8","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" Which condition(s) or situation(s) could be responsible for the results of the martial assessment observed in this patient?","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"inflammatory syndrome","justification":""},{"idx":1,"correct":false,"proposition":"non-alcoholic steatohepatitis","justification":""},{"idx":2,"correct":false,"proposition":"rhabdomyolysis","justification":""},{"idx":3,"correct":true,"proposition":"Genetic hemochromatosis","justification":""},{"idx":4,"correct":false,"proposition":"hyperthyroidism","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-9-qi-9","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" You mention genetic hemochromatosis. Genetic analysis reveals a homozygous C282Y mutation in the HFE gene. Regarding the joint pain of which he complains, what elements would lead to an osteo-articular attack of his hemochromatosis? (one or more possible answers)","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Metacarpophalangeal involvement","justification":""},{"idx":1,"correct":true,"proposition":"Pseudo-gout attacks","justification":""},{"idx":2,"correct":false,"proposition":"erosion of distal interphalangeal","justification":""},{"idx":3,"correct":true,"proposition":"Radiological calcium border","justification":""},{"idx":4,"correct":true,"proposition":"  osteophytosis in hook of the heads of the metacarpals","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-9-qi-10","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" What examination(s) do you ask Mr. R to assess the possible impact of his hemochromatosis?","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"trans-thoracic cardiac ultrasound","justification":""},{"idx":1,"correct":false,"proposition":"coronary angiography","justification":""},{"idx":2,"correct":false,"proposition":"Whole body bone scintigraphy","justification":""},{"idx":3,"correct":true,"proposition":"testosteronemia","justification":""},{"idx":4,"correct":true,"proposition":"bone densitometry","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-9-qi-11","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" The results of the examinations are as follows:- trans-thoracic cardiac ultrasound: left ventricular ejection fraction 65%, normal filling pressures, undilated heart chambers, absence of valvular heart disease;- testosteronemia (total): 0.5 ng \/ mL (normal: 2.5 - 10); - vitamin D 10 ng \/ mL, serum calcium 2.2 mmol \/ L, phosphoremia 1.1 mmol \/ L;- bone densitometry: T-score at -2 at the lumbar spine, T-score at -1.8 at the femoral neck.- as a reminder,  the biological assessment has previously highlighted: transferrin saturation coefficient 80%, ferritin 2450 μg\/L, negative anti-HCV antibody test, HBs antigen: negative, anti-HBs antibodies: positive with 100 IU\/L level, anti-HBc antibodies: negative. What measure(s) should be put in place? ","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"vaccination against hepatitis B","justification":""},{"idx":1,"correct":false,"proposition":"vitamin C supplementation","justification":""},{"idx":2,"correct":true,"proposition":"vitamin D supplementation","justification":""},{"idx":3,"correct":true,"proposition":"Avoidance of alcohol","justification":""},{"idx":4,"correct":false,"proposition":"oral iron chelator","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-9-qi-12","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" Vitamin D supplementation is implemented, and you inform Mr. R of the importance of stopping alcohol consumption during pathology. You also start a depletive treatment with bloodletting. Regarding the methods, objectives and elements of bloodletting monitoring that you are going to set up at Mr. R, which is (are) accurate?","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Initially monthly rhythm in the attack phase","justification":""},{"idx":1,"correct":true,"proposition":"regular monitoring of ferritinemia","justification":""},{"idx":2,"correct":false,"proposition":"annual liver biopsy","justification":""},{"idx":3,"correct":true,"proposition":"suspension of bleeding if the blood haemoglobin test falls below 11 g\/dL","justification":""},{"idx":4,"correct":true,"proposition":"Initiation of bloodletting in a hospital setting","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-9-qi-13","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" Mr. R. asks you about the mechanisms behind his disease and iron metabolism. Which proposal(s) is(are) accurate?","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Iron absorption occurs mainly in the ileum","justification":""},{"idx":1,"correct":false,"proposition":"Hepcidin is increased during genetic hemochromatosis","justification":""},{"idx":2,"correct":true,"proposition":"Hepcidin inhibits the absorption of iron by the enterocyte","justification":""},{"idx":3,"correct":true,"proposition":"Hepcidin inhibits the release of iron by macrophages","justification":""},{"idx":4,"correct":false,"proposition":"Hepcidin is made by the kidney","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-9-qi-14","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" What genetic counseling will you offer Mr. R about his relatives? (one or more possible answers)","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"his 3 children must have a search for HFE mutation within the year","justification":""},{"idx":1,"correct":false,"proposition":"C282Y heterozygosity is associated with a minor form with moderate iron overload","justification":""},{"idx":2,"correct":true,"proposition":"his children have a one in 2 risk of being homozygous if his wife is heterozygous","justification":""},{"idx":3,"correct":true,"proposition":"Genetic testing in relatives is covered by health insurance","justification":""},{"idx":4,"correct":false,"proposition":"the attending physician should contact the patient's siblings for CST, ferritin and HFE genetic testing","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-9-qi-15","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" What follow-up exam(s) do you propose to Mr. R?","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"liver ultrasound every 6 months","justification":"This question has been rescinded"},{"idx":1,"correct":false,"proposition":"beta-2 microglobulin every 6 months","justification":"This question has been rescinded"},{"idx":2,"correct":true,"proposition":"blood count before bleeding","justification":"This question has been rescinded"},{"idx":3,"correct":false,"proposition":"Cardiac MRI with annual iron overload measurement","justification":"This question has been rescinded"},{"idx":4,"correct":true,"proposition":"regular gastro-duodenal endoscopy","justification":"This question has been rescinded"}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-10-qi-1","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" What is most suggestive of the central origin of facial paralysis?","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Asymmetry of the mouth with sagging of the labial commissure","justification":""},{"idx":1,"correct":true,"proposition":"Facial asymmetry more marked during voluntary movements than during automatic movements","justification":""},{"idx":2,"correct":false,"proposition":"Deviation of the tongue to the left during protraction","justification":""},{"idx":3,"correct":false,"proposition":"Sign of Souque's eyelashes during forced occlusion of the eyes","justification":""},{"idx":4,"correct":false,"proposition":"Left hearing loss","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-10-qi-2","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" What element(s) of favorable prognosis do you retain in this patient?","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Age","justification":""},{"idx":1,"correct":true,"proposition":"Incomplete upper limb deficit","justification":""},{"idx":2,"correct":false,"proposition":"The moderate nature of proprioceptive sensory disorders","justification":""},{"idx":3,"correct":true,"proposition":"The ability to sit still","justification":""},{"idx":4,"correct":false,"proposition":"The presence of swallowing disorders","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-10-qi-3","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" Given the clinical elements, which of the professionals mentioned below will you solicit?","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Physiotherapist","justification":""},{"idx":1,"correct":true,"proposition":"Occupational therapist","justification":""},{"idx":2,"correct":true,"proposition":"Speech therapist","justification":""},{"idx":3,"correct":false,"proposition":"Prosthetist","justification":""},{"idx":4,"correct":false,"proposition":"Podo-orthotist","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-10-qi-4","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" You have asked a physiotherapist, an occupational therapist and a speech therapist for the patient's rehabilitation program. After the speech-language pathologist has carried out an initial assessment, what elements will he have to work on to improve the patient's health? (one or more correct answers)","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"On the motor skills of the face","justification":""},{"idx":1,"correct":true,"proposition":"On the phases of swallowing","justification":""},{"idx":2,"correct":true,"proposition":"On the adaptation of meal textures","justification":""},{"idx":3,"correct":false,"proposition":"On the improvement of language disorders","justification":""},{"idx":4,"correct":true,"proposition":"On improving articulation","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-10-qi-5","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" His rehabilitation is going normally and you are planning a therapeutic weekend. Given the age and fragility of the patient, you are considering a nursing visit morning and evening. His wife asks you about the necessary elements for this therapeutic outing. She is also worried because the arrangements for her Sunday are not made. What information can you provide? (one or more exact propositions)","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Nursing care is covered by the health insurance fund","justification":""},{"idx":1,"correct":false,"proposition":"It will have to send the medical transport vouchers issued for the weekend to the departmental home for disabled people","justification":""},{"idx":2,"correct":true,"proposition":"If necessary, she can call her doctor or an emergency department during the weekend.","justification":""},{"idx":3,"correct":true,"proposition":"An occupational therapist will be able to best define with her the arrangements of her home","justification":""},{"idx":4,"correct":false,"proposition":"To make adjustments to her home, she will have to call on the departmental home for people with disabilities.","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-10-qi-6","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" Seven weeks after admission, the patient falls. He has left hip pain. The hospital student reports the data of his clinical examination to you. What proposals are compatible with a fracture of the upper end of the left femur? (one or more exact propositions)","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Absence of deformation","justification":""},{"idx":1,"correct":false,"proposition":"A vicious attitude in irreducible internal rotation","justification":""},{"idx":2,"correct":true,"proposition":"An externally rotating left lower limb","justification":""},{"idx":3,"correct":true,"proposition":"Shortening of the lower left limb","justification":""},{"idx":4,"correct":true,"proposition":"A left lower limb in adduction","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-10-qi-7","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" You ask for X-rays as follows:What is your diagnosis?","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"normal x-rays","justification":""},{"idx":1,"correct":true,"proposition":"basicervical fracture","justification":""},{"idx":2,"correct":false,"proposition":"Iliopubic branch fracture","justification":""},{"idx":3,"correct":false,"proposition":"Subtrochanteric fracture","justification":""},{"idx":4,"correct":false,"proposition":"Garden 1 cervical fracture","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-10-qi-8","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" The radiologist sends you his report with a diagnosis of coxarthrosis associated with a basicervical fracture. What proposals can treat both fracture and coxarthrosis? (one or more exact propositions)","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Head of spinal cord nailing","justification":""},{"idx":1,"correct":false,"proposition":"Osteosynthesis by dynamic plate screw","justification":""},{"idx":2,"correct":false,"proposition":"Intermediate hip replacement","justification":""},{"idx":3,"correct":true,"proposition":"Total hip replacement","justification":""},{"idx":4,"correct":false,"proposition":"Trans-skeletal traction","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-10-qi-9","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" The patient received a total left hip replacement. Postoperatively, he presented with a hematoma of the thigh that required the cessation of anticoagulation and the transfusion of 2 red blood cells. He is transferred to the neurological follow-up care unit with his blood type card. On arrival a biological assessment shows: albumin 35 g \/ L (34-50); Calcium 1.90 mmol\/L (2.08-2.65); serum folate 7.9 nmol\/L (normal if greater than 12); vitamin B12 371 pmol\/L (156-672); Ultrasensitive TSH 0.460 mIU\/L (0.400-4.00). In view of these elements and for the purpose of prevention, which of the following treatments are you prescribing immediately?","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Calcium","justification":""},{"idx":1,"correct":false,"proposition":"Alendronate","justification":""},{"idx":2,"correct":true,"proposition":"Vitamin d","justification":""},{"idx":3,"correct":false,"proposition":"Denosumab","justification":""},{"idx":4,"correct":false,"proposition":"Hormone therapy","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-10-qi-10","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" The patient is treated with calcium 1 g per day and vitamin D3 100,000 IU every 15 days for 3 months. Ten days after surgery a parapixaban treatment is resumed. Five days later, he has a very marked increase in the hematoma of the left thigh associated with a feeling of fatigue and a great mucocutaneous pallor. His blood pressure is at 100\/50mmHg his heart rate at 74 beats per minute. Its temperature is 37.2°C.What additional examinations do you prescribe urgently? (one or more exact propositions)","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Complete blood count","justification":""},{"idx":1,"correct":false,"proposition":"Pelvic X-ray","justification":""},{"idx":2,"correct":true,"proposition":"Thigh scanner","justification":""},{"idx":3,"correct":true,"proposition":"Search for irregular agglutinins","justification":""},{"idx":4,"correct":false,"proposition":"INR","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-10-qi-11","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" Faced with the situation you evoke acute bleeding and ask the nurse to urgently order 3 red blood cells. The search for irregular agglutinins is negative. Which proposal(s) apply to your patient?","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"you ask the patient for permission to consider a transfusion","justification":""},{"idx":1,"correct":false,"proposition":"you write a prescription for long-term illness (ALD) for 3 red blood cells","justification":""},{"idx":2,"correct":false,"proposition":"In this context of multiple transfusion you ask for compatible pellets","justification":""},{"idx":3,"correct":false,"proposition":"you check the patient's bedside Rhesus D compatibility with the Beth-Vincent test","justification":""},{"idx":4,"correct":false,"proposition":"You ask for irradiated red blood cells in front of this context of fragility","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-10-qi-12","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" When administering the third red blood cell, the nurse calls you because the patient shivers, and his temperature is at 39.2°C.What proposals apply to your patient? (one or more exact propositions)","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"You stop the transfusion without delay","justification":""},{"idx":1,"correct":true,"proposition":"You will need to make a haemovigilance declaration","justification":""},{"idx":2,"correct":true,"proposition":"You call the blood transfusion centre","justification":""},{"idx":3,"correct":true,"proposition":"You address the blood bag that passed at the time of the febrile episode to the laboratory according to the local procedure","justification":""},{"idx":4,"correct":true,"proposition":"You have blood cultures taken","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-10-qi-13","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" The bleeding episode is controlled and there were no other post-transfusion complications. The patient can resume walking after 3 weeks and is considering returning home. Which of the following suggestions concerning the information you should include on the physiotherapy prescription apply to your patient? (one or more exact propositions)","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"If the prescription is at home it must include the number of sessions","justification":""},{"idx":1,"correct":true,"proposition":"If the prescription is in the physiotherapist's office, it must include the mention \"physiotherapy treatments (or sessions)\"","justification":""},{"idx":2,"correct":false,"proposition":"If you want to insist on the recovery of hip joint amplitudes, you must precisely define on the prescription the number of sessions spent on this goal","justification":""},{"idx":3,"correct":true,"proposition":"If you want physiotherapy at home you must explicitly stipulate this on the prescription","justification":""},{"idx":4,"correct":true,"proposition":"If you want rehabilitation of the lower right limb and left hemiplegia you can register it on the same prescription","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-10-qi-14","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" You are considering home help. Which of the following proposals do you consider for your patient? (one or more exact proposals)","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Applying for a disabled adult allowance","justification":""},{"idx":1,"correct":true,"proposition":"Application for a personalized autonomy allowance","justification":""},{"idx":2,"correct":false,"proposition":"Applying for a special education allowance","justification":""},{"idx":3,"correct":false,"proposition":"Application for compensation benefit","justification":""},{"idx":4,"correct":true,"proposition":"Applying for a home help","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-12-qi-1","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" Controls report an initial loss of consciousness estimated at 2 minutes. The patient has a motor response adapted to simple commands, opens his eyes to demand, reveals his identity and is correctly located in time and space. The case is a 38-year-old man with no known medical history. How much do you estimate his score in Glasgow? (only one answer expected)","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"14","justification":""},{"idx":1,"correct":false,"proposition":"12","justification":""},{"idx":2,"correct":false,"proposition":"10","justification":""},{"idx":3,"correct":false,"proposition":"8","justification":""},{"idx":4,"correct":false,"proposition":"6","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-12-qi-2","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" You estimate the Glasgow score at 14.Which of the following proposition(s) is true for this patient?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"There is an indication of cranioencephalic CT","justification":""},{"idx":1,"correct":false,"proposition":"The score is modified by the existence of an initial loss of consciousness","justification":""},{"idx":2,"correct":true,"proposition":"The score must be reassessed upon arrival at the hospital","justification":""},{"idx":3,"correct":false,"proposition":"There is an indication for airway protection by intubation","justification":""},{"idx":4,"correct":true,"proposition":"The score could be altered by taking psychotropic drugs","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-12-qi-3","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" The patient mainly complains of pain in the right lower limb and right upper limb. In the right upper limb there is a deformity of the arm. The patient has functional impotence. You suspect a fracture of the humerus and seek to rule out paralysis of the radial nerve. To do this, what do you test specifically? (one or more correct answers)","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Altered sensitivity of the medial edge of the hand","justification":""},{"idx":1,"correct":false,"proposition":"Altered sensitivity of the thumb pulp","justification":""},{"idx":2,"correct":true,"proposition":"A deficit of active extension of the thumb","justification":""},{"idx":3,"correct":true,"proposition":"A deficit of active wrist extension","justification":""},{"idx":4,"correct":false,"proposition":"A deficit of active abduction\/adduction of long fingers","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-12-qi-4","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" At the level of the right knee, there is a large anterior wound, and a free bone fragment of the femoral condyle is externalized. Distal pulses are well perceived. Which of the following actions do you think is appropriate and to be implemented on the spot as a first intention?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Wound cleansing with an alcoholic antiseptic solution","justification":""},{"idx":1,"correct":true,"proposition":"Rinsing the wound with saline","justification":""},{"idx":2,"correct":false,"proposition":"Placing and tightening a tourniquet at the root of the thigh","justification":""},{"idx":3,"correct":true,"proposition":"Alignment of the lower limb in a splint","justification":""},{"idx":4,"correct":true,"proposition":"Moderately compressive sterile dressing","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-12-qi-5","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" The patient is unable to lift his leg by holding the knee in extension. A photograph of the wound is shown below. Which of the following applies?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"This is a joint wound","justification":""},{"idx":1,"correct":false,"proposition":"This is a punctiform wound","justification":""},{"idx":2,"correct":true,"proposition":"A rupture of the extender apparatus is suspected","justification":""},{"idx":3,"correct":true,"proposition":"The mobilization of the knee in flexion puts tension on the skin banks","justification":""},{"idx":4,"correct":true,"proposition":"Management of this wound requires extensive surgical debridement","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-12-qi-6","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" Haemodynamic stability of the patient was achieved with the infusion of 750 ml of crystalloid during transport. Which of the following anamnestic and clinical elements is (are) in favor of performing a whole body scan?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"The estimated speed at the time of the accident was 75 km\/h","justification":""},{"idx":1,"correct":false,"proposition":"The patient has a Glasgow score calculated at 14","justification":""},{"idx":2,"correct":false,"proposition":"There is a joint wound of the right knee","justification":""},{"idx":3,"correct":true,"proposition":"An evolution requiring the introduction of vasopressive amines","justification":""},{"idx":4,"correct":false,"proposition":"Seat belt use","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-12-qi-7","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" X-rays of the right knee front and profile as well as frontal reconstructions of the CT scan are attached. Which of the following is (are) correct?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"There is a fracture involving the tip of the patella","justification":""},{"idx":1,"correct":false,"proposition":"There is a supracondylar fracture of the distal femur","justification":""},{"idx":2,"correct":true,"proposition":"There is a fracture of the lateral femoral condyle","justification":""},{"idx":3,"correct":false,"proposition":"There is a fracture of the proximal metaphysis of the tibia","justification":""},{"idx":4,"correct":true,"proposition":" There is an ascent of the patella","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-12-qi-8","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" The whole body scanner finds no lesions other than those of the limbs. Injuries to the right knee and arm were managed in the operating room. At the knee, it was indeed a fracture of the lateral condyle, which was reinserted and osteosynthesized, and a fracture of the tip of the patella which was equivalent to an avulsion of the patellar ligament at the tip of the patella. Due to the articular nature of the lateral ducondyle fracture, you postpone the resumption of support during the 3rd postoperative month. To promote skin healing, you limit flexion to 90° during the first month after surgery. Post-operatively, you inform the patient of the progressive risks. What are the exact proposition(s) regarding the risk of postoperative stiffness?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"The limitation of the prescribed flexion is intended to promote the healing of the intra- and extra-articular elements","justification":""},{"idx":1,"correct":true,"proposition":"The intra-articular nature of the lesion increases the risk of stiffness","justification":""},{"idx":2,"correct":false,"proposition":"In the absence of complex regional pain syndrome type 1, there should be no loss of long-term mobility","justification":""},{"idx":3,"correct":true,"proposition":"The existence of a significant limitation of the flexion amplitude to 6 weeks after surgery may lead to discussion of mobilization under anesthesia","justification":""},{"idx":4,"correct":true,"proposition":"The persistence of stiffness beyond 3 months can be recovered by surgery","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-12-qi-9","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" For his rehabilitation, he is cared for in a follow-up care and rehabilitation department in a day hospital and wonders about the long-term goals of this treatment. Which of the following information(s) is (are) accurate and that you can give him?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"The knee will have to bend at least 110° for it to descend the stairs normally","justification":""},{"idx":1,"correct":true,"proposition":"A strengthening of the thigh muscles is necessary to ensure good stability in the phase of support to walking","justification":""},{"idx":2,"correct":true,"proposition":"The work of endurance to the effort will facilitate its resumption of activity","justification":""},{"idx":3,"correct":false,"proposition":"An evaluation of his workstation by the departmental home for disabled people will have to be organized","justification":""},{"idx":4,"correct":true,"proposition":"A regular assessment of participation restrictions will be made by a physical medicine and rehabilitation doctor throughout his recovery.","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-12-qi-10","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" Which of the following proposals is (are) the professional(s) who you think should be solicited for the rehabilitation of this patient?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"physiotherapist","justification":""},{"idx":1,"correct":true,"proposition":"occupational therapist","justification":""},{"idx":2,"correct":false,"proposition":"psychomotor therapist","justification":""},{"idx":3,"correct":false,"proposition":"Pedo-orthotist","justification":""},{"idx":4,"correct":true,"proposition":"Adapted physical activity teacher","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-12-qi-11","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" During the consultation he asks you about his professional future because he is worried. His accident is an accident at work (commuting accident). He has still not received daily allowance. Which of the following is (are) the exact answer(s)?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Knee pain may persist despite good consolidation","justification":""},{"idx":1,"correct":false,"proposition":"You confirm that his daily allowances will not be paid until he is released from hospital.","justification":""},{"idx":2,"correct":true,"proposition":"If he retains sequelae, he may request an evaluation which may give rise to compensation by the health insurance fund.","justification":""},{"idx":3,"correct":false,"proposition":"The adaptation of one's workstation may be carried out by the health insurance fund.","justification":""},{"idx":4,"correct":true,"proposition":"If necessary, the departmental home for disabled people may award him a certificate of disabled worker status.","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-12-qi-12","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" After two months, he was allowed to gradually resume support on the lower right limb. During follow-up, the patient complains of the gradual appearance of pain in the upper left limb, with an impression of numbness of the fingers. The phenomena are increased at the end of the day when he leans on his English cane. Which of the following elements of the clinical examination is (are) in favor of carpal tunnel syndrome?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Percussion next to the flexion fold of the wrist triggers pain","justification":""},{"idx":1,"correct":false,"proposition":"Painful phenomena increase when bending the elbow","justification":""},{"idx":2,"correct":false,"proposition":"Pain predominates in the last two fingers","justification":""},{"idx":3,"correct":true,"proposition":"Prolonged wrist flexion increases pain","justification":""},{"idx":4,"correct":false,"proposition":"  There is amyotrophy of the hypothenar eminence","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-12-qi-13","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" The situation does not improve despite the gradual abandonment of the English cane on the left with persistent pain and paresthesias in the left hand. You suspect a comprehension of the ulnar nerve. What test do you prescribe to determine its location and impact? (only one answer expected)","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Ultrasound of the wrist","justification":""},{"idx":1,"correct":false,"proposition":"X-rays of the elbow and wrist","justification":""},{"idx":2,"correct":true,"proposition":"Comparative electroneuromyogram of the two upper limbs","justification":""},{"idx":3,"correct":false,"proposition":"Dynamic X-rays of the cervical spine","justification":""},{"idx":4,"correct":false,"proposition":"Cervical MRI","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-12-qi-14","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" The electromyogram confirmed compression of the ulnar nerve but the symptoms gradually improved with the disappearance of paresthesia. The evolution of pain and strength was favorable to the lower right limb after 4 months of rehabilitation but he remains embarrassed for the descent of the stairs because the flexion of the knee reaches only 100 °. However, you are concerned because it retains pain in the upper right limb. Yet you notice a very good evolution both in the strength and amplitudes of the shoulder and elbow which have returned to normal. You gave him a prescription for physiotherapy sessions without specifying the number. Among the following proposals, which is (are) the one (s) you can make for his outpatient follow-up?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Physiotherapy may also be accompanied by balneotherapy despite the absence of specific mention on the prescription","justification":""},{"idx":1,"correct":false,"proposition":"The conditions of management of occupational therapy are no different from physiotherapy-balneotherapy","justification":""},{"idx":2,"correct":true,"proposition":"The physiotherapist will be able to adapt the number of sessions by himself without this posing any problem of coverage by the social security","justification":""},{"idx":3,"correct":false,"proposition":"It is not necessary to see the surgeon again before 18 months given the severity of the fractures","justification":""},{"idx":4,"correct":false,"proposition":"Physiotherapy can be performed at home despite the absence of specific mention on the prescription","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-12-qi-15","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" Since the patient fails to carry a load on the right side at 6 months postoperatively, you decided to refer him back to the surgeon. Here is the radiographic aspect on front and profile images. Which proposal(s) is (are) true?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"This is hypertrophic pseudarthrosis","justification":""},{"idx":1,"correct":true,"proposition":"The chances of spontaneous consolidation at this stage are minimal in the absence of intervention","justification":""},{"idx":2,"correct":false,"proposition":"This is the normal course of a fracture after osteosynthesis.","justification":""},{"idx":3,"correct":false,"proposition":"This is a vicious aspect of callus","justification":""},{"idx":4,"correct":true,"proposition":"The osteosynthesis material in place is a centromedullary nail","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-13-qi-1","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" What do you think is the most important thing to collect during questioning? (only one answer expected)","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"a family history of systemic inflammatory disease","justification":""},{"idx":1,"correct":false,"proposition":"A triggering factor","justification":""},{"idx":2,"correct":false,"proposition":"a cardiovascular history","justification":""},{"idx":3,"correct":false,"proposition":"A recent trip","justification":""},{"idx":4,"correct":true,"proposition":"the pain schedule","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-13-qi-2","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" What is (are) the element(s) that orient you towards an inflammatory nature of pain?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Awakenings at the end of the night","justification":""},{"idx":1,"correct":false,"proposition":"difficulty falling asleep","justification":""},{"idx":2,"correct":false,"proposition":"10-minute morning stiffness","justification":""},{"idx":3,"correct":true,"proposition":"persistence of pain at rest","justification":""},{"idx":4,"correct":false,"proposition":"progressive worsening of pain during the day","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-13-qi-3","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" Joint pain is inflammatory. What are the three most likely diagnoses in this patient to explain all the symptoms?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"rheumatoid arthritis","justification":""},{"idx":1,"correct":true,"proposition":"scleroderma","justification":""},{"idx":2,"correct":false,"proposition":"a drop","justification":""},{"idx":3,"correct":true,"proposition":"lung cancer","justification":""},{"idx":4,"correct":false,"proposition":"myeloma","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-13-qi-4","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" Your clinical examination objective the abnormalities visualized in the following photograph. What do you suspect (one or more possible answers)?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Tophus","justification":""},{"idx":1,"correct":true,"proposition":"rheumatoid nodules","justification":""},{"idx":2,"correct":false,"proposition":"erythema nodosum","justification":""},{"idx":3,"correct":false,"proposition":"Heberden's nodules","justification":""},{"idx":4,"correct":false,"proposition":"multiple abscesses","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-13-qi-5","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" You prescribe a biological assessment. Which of the following proposals do you think is relevant at this stage?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"HLA typing","justification":""},{"idx":1,"correct":true,"proposition":"CRP","justification":""},{"idx":2,"correct":false,"proposition":"Antiphospholipid antibodies","justification":""},{"idx":3,"correct":true,"proposition":"anti-citrullinated peptide (ACPA) antibodies","justification":""},{"idx":4,"correct":true,"proposition":"anti-nuclear antibodies","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-13-qi-6","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" The immunological assessment shows: negative anti-citrullinated peptide antibodies (ACPA), anti-nuclear antibodies positive at 1\/80 without specificity, a rheumatoid factor positive. CRP is 60 mg\/L.Given all the clinical and paraclinical information available at this stage, what is the most likely diagnosis?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"a drop","justification":""},{"idx":1,"correct":true,"proposition":"rheumatoid arthritis","justification":""},{"idx":2,"correct":false,"proposition":"psoriatic arthritis","justification":""},{"idx":3,"correct":false,"proposition":"lupus","justification":""},{"idx":4,"correct":false,"proposition":"scleroderma","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-13-qi-7","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" Faced with this distal, bilateral and symmetrical polyarthritis, the presence of rheumatoid nodules and the positivity of rheumatoid factor, you have made the diagnosis of rheumatoid arthritis and started a background treatment with methotrexate. The patient has progressive dyspnea stage 2 on the modified Medical Research Council (mMRC) scale that has been on for six months now. The objective auscultation of the dry crackling of the two bases. The rest of the chest examination is normal. The heart rate is regular without any particular breath. What do you suspect first (only one answer expected)?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"chronic bronchitis","justification":""},{"idx":1,"correct":false,"proposition":"pleural effusion","justification":""},{"idx":2,"correct":false,"proposition":"infectious pneumonia","justification":""},{"idx":3,"correct":true,"proposition":"diffuse interstitial lung disease","justification":""},{"idx":4,"correct":false,"proposition":"diaphragmatic paralysis","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-13-qi-8","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" Faced with this suspicion of diffuse interstitial lung disease, what are the two most relevant complementary examinations?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"bronchial fibroscopy with LBA","justification":""},{"idx":1,"correct":true,"proposition":"EFRs with DLCO measurement","justification":""},{"idx":2,"correct":true,"proposition":"a chest CT scan","justification":""},{"idx":3,"correct":false,"proposition":"echocardiography","justification":""},{"idx":4,"correct":false,"proposition":"a pulmonary ventilation\/perfusion scan","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-13-qi-9","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" You complete your approach by performing a chest CT scan, a section of which is attached. What basic lesion(s) do you observe on this scanner?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"pleural effusion","justification":""},{"idx":1,"correct":false,"proposition":"condensation erasing vascular structures","justification":""},{"idx":2,"correct":false,"proposition":"micronodules","justification":""},{"idx":3,"correct":true,"proposition":"intralobular cross-linking","justification":""},{"idx":4,"correct":true,"proposition":"traction bronchiectasis","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-13-qi-10","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" You perform pulmonary function tests:What is (are) the exact answer(s)?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Diffusion disorder","justification":""},{"idx":1,"correct":false,"proposition":"obstructive syndrome","justification":""},{"idx":2,"correct":true,"proposition":"restrictive syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Significant reversibility","justification":""},{"idx":4,"correct":false,"proposition":"shunt","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-13-qi-11","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" You are diagnosed with diffuse interstitial lung disease related to rheumatoid arthritis. Two years later, on the blood test, isolated neutropenia was found at 789\/mm3. The patient is asthenic. He has no fever. On examination, you find splenomegaly. Which diagnosis do you think is most likely?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"rheumatoid vasculitis","justification":""},{"idx":1,"correct":false,"proposition":"schistosomiasis","justification":""},{"idx":2,"correct":false,"proposition":"Gaucher disease","justification":""},{"idx":3,"correct":false,"proposition":"hairy cell leukemia","justification":""},{"idx":4,"correct":true,"proposition":"Felty's syndrome","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-13-qi-12","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" You are diagnosed with Felty's syndrome. The patient is now being treated with immunosuppressants. He contacts you again after 3 months of treatment due to a worsening of dyspnea for two days with dyspnea at the slightest effort. The respiratory rate is 35 cycles per minute, hemodynamics are stable. Saturation is 95% under 6 liters of oxygen per minute. Pulmonary auscultation finds bilateral crackling at the bases. Vocal vibrations are unchanged and chest percussion is normal. What are the three diagnoses that you first mention in the face of this brutal decompensation?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"pulmonary embolism","justification":""},{"idx":1,"correct":false,"proposition":"lung cancer","justification":""},{"idx":2,"correct":false,"proposition":"pneumothorax","justification":""},{"idx":3,"correct":true,"proposition":"pneumocystosis","justification":""},{"idx":4,"correct":true,"proposition":"community-acquired acute pneumonia","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-13-qi-13","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" Given the severity of the patient, you hospitalize him. The temperature is 38.6°C.  An X-ray of the chest in bed is performed while sitting. What do you see? (one or more correct answers)","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"right pleural effusion","justification":""},{"idx":1,"correct":false,"proposition":"left apical pneumothorax","justification":""},{"idx":2,"correct":false,"proposition":"cardiomegaly","justification":""},{"idx":3,"correct":true,"proposition":"Alveolar opacities on the left","justification":""},{"idx":4,"correct":true,"proposition":"Bilateral interstitial opacities","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-13-qi-14","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" Severity criteria dictate that you transfer your patient to critical care. What sample(s) do you take to make the microbiological diagnosis of this infectious pneumonitis?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Legionella antigenuria","justification":""},{"idx":1,"correct":true,"proposition":"Blood","justification":""},{"idx":2,"correct":true,"proposition":"Multiplex PCR on nasopharyngeal swab","justification":""},{"idx":3,"correct":true,"proposition":"cytobacteriological examination of sputum","justification":""},{"idx":4,"correct":true,"proposition":"pneumococcal antigenuria","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-13-qi-15","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" While waiting for microbiological results, which probabilistic antibiotic therapy do you prescribe? (one or more correct answers)","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Spiramycin intravenously","justification":""},{"idx":1,"correct":false,"proposition":"intravenous amoxicillin","justification":""},{"idx":2,"correct":true,"proposition":"intravenous cefotaxime","justification":""},{"idx":3,"correct":false,"proposition":"Intravenous ciprofloxacin","justification":""},{"idx":4,"correct":false,"proposition":"intravenous metronidazole","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-13-qi-16","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" The microbiological balance is negative. Nevertheless, the patient's course is favorable after 7 days of treatment with cefotaxime and spiramycin. The patient returns home but is unable to leave easily due to fatigue. It retains bronchial congestion. You decide to continue chest physiotherapy. What elements must be included on the prescription? (one or more correct answers)","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"the mention << home physiotherapy>>","justification":""},{"idx":1,"correct":false,"proposition":"the number of sessions you plan","justification":""},{"idx":2,"correct":false,"proposition":"diagnosis and type of pneumonia","justification":""},{"idx":3,"correct":false,"proposition":"the frequency of sessions per week","justification":""},{"idx":4,"correct":true,"proposition":"the mention << seven days a week>> if you consider weekend care necessary","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-14-qi-1","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" Faced with this complicated fall from a head trauma, what elements justify the realization of an emergency brain scan? (one or more correct answers)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Age","justification":""},{"idx":1,"correct":false,"proposition":"Suspected syncope","justification":""},{"idx":2,"correct":true,"proposition":"Taking anticoagulant","justification":""},{"idx":3,"correct":true,"proposition":"Confusion","justification":""},{"idx":4,"correct":false,"proposition":"Polypathology","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-14-qi-2","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" Which proposals are correct regarding the brain scan? (one or more correct answers)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Old bifrontal subdural collection","justification":""},{"idx":1,"correct":true,"proposition":"Subcortical atrophy","justification":""},{"idx":2,"correct":false,"proposition":"Signs of intracranial hypertension","justification":""},{"idx":3,"correct":true,"proposition":"Recent subdural hemorrhage","justification":""},{"idx":4,"correct":false,"proposition":"Right occipital old ischemic sequelae","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-14-qi-3","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" Among the tests requested, the INR is 2.1. What therapeutic measures are you putting in place regarding anticoagulant treatment? (one or more possible answers)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"  Intravenous vitamin K prescription","justification":""},{"idx":1,"correct":true,"proposition":"Prescription of concentrate of prothrombin complexes","justification":""},{"idx":2,"correct":true,"proposition":"Discontinuation of coumadin treatment","justification":""},{"idx":3,"correct":false,"proposition":"Prescription of an antiplatelet agent","justification":""},{"idx":4,"correct":false,"proposition":"Prescription of a low molecular weight heparin at a prophylactic dose","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-14-qi-4","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" You stop coumadin, inject vitamin K and concentrate of prothrombin complexes intravenously. What monitoring measures do you put in place? (one or more correct answers)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Platelet count at 30 minutes","justification":""},{"idx":1,"correct":true,"proposition":"INR check at 30 minutes","justification":""},{"idx":2,"correct":false,"proposition":"Anti-Xa activity","justification":""},{"idx":3,"correct":true,"proposition":"INR control at 6 a.m.","justification":""},{"idx":4,"correct":false,"proposition":"Factor V assay at 6 o'clock","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-14-qi-5","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" The controlled INR at 30 minutes is 1.1. As part of the exploration of the patient's chest pain, you perform an ECG and chest X-ray. What etiological diagnosis do you retain for this chest pain? (only one exact answer)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Pulmonary embolism","justification":""},{"idx":1,"correct":false,"proposition":"Pneumonia of the right base","justification":""},{"idx":2,"correct":true,"proposition":"Rib fracture","justification":""},{"idx":3,"correct":false,"proposition":"Pneumothorax","justification":""},{"idx":4,"correct":false,"proposition":"Acute coronary syndrome","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-14-qi-6","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" Biologically, you note a natremia at 128 mmol \/ L. What additional elements can be used to explore this result? (one or more correct answers)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Urinary ionogram","justification":""},{"idx":1,"correct":true,"proposition":"Protidemia","justification":""},{"idx":2,"correct":false,"proposition":"Serum anti-diuretic hormone assay","justification":""},{"idx":3,"correct":false,"proposition":"Total cholesterolemia","justification":""},{"idx":4,"correct":false,"proposition":"Proteinuria","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-14-qi-7","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" Protein and blood sugar are normal. The appearance of the serum is normal. You conclude hypoosmotic hyponatremia.   Kidney function is normal. The urinary ionogram reveals: natriuresis 60 mmol \/ L; kaliuresis 30 mmol\/L; urinary urea 250 mmol\/L.What are the two etiologies you mention at this stage?","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Syndrome of inappropriate DHA secretion related to serotonin reuptake inhibitor therapy","justification":""},{"idx":1,"correct":true,"proposition":"Syndrome of inappropriate DHA secretion related to chronic subdural hematoma","justification":""},{"idx":2,"correct":false,"proposition":"Potomania","justification":""},{"idx":3,"correct":false,"proposition":"Water retention related to calcium channel blocker treatment","justification":""},{"idx":4,"correct":false,"proposition":"Syndrome of inappropriate DHA secretion related to pleural effusion","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-14-qi-8","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" What therapeutic measures do you take with regard to this hyponatremia? (one or more correct answers)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Water restriction","justification":""},{"idx":1,"correct":false,"proposition":"NaCl infusion 9‰ 1000 ml\/24h","justification":""},{"idx":2,"correct":false,"proposition":"Treatment with loop diuretic","justification":""},{"idx":3,"correct":false,"proposition":"Sodium intake per os at 12 g \/ 24 hours","justification":""},{"idx":4,"correct":true,"proposition":"Discontinuation of serotonin reuptake inhibitor therapy","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-14-qi-9","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" You suspect syncope. Returning to the interrogation, the patient's daughter tells you that this is the second episode of sudden discomfort in a month, but her mother was not injured last time. What abnormalities do you notice on the ECG (same trace as question 5)? (one or more possible answers)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Full left branch block","justification":""},{"idx":1,"correct":true,"proposition":"Full right branch block","justification":""},{"idx":2,"correct":true,"proposition":"Left anterior hemiblock","justification":""},{"idx":3,"correct":false,"proposition":"Left posterior hemiblock","justification":""},{"idx":4,"correct":false,"proposition":"Atrial fibrillation","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-14-qi-10","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" What diagnosis do you mention in priority in this patient regarding the etiology of her syncopes?","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Tight aortic stricture","justification":""},{"idx":1,"correct":false,"proposition":"Severe pulmonary embolism","justification":""},{"idx":2,"correct":true,"proposition":"Atrioventricular block of the paroxysmal 3rd degree","justification":""},{"idx":3,"correct":false,"proposition":"Paroxysmal ventricular tachycardia","justification":""},{"idx":4,"correct":false,"proposition":"Orthostatic hypotension","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-14-qi-11","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" Since her admission, the patient has spoken incoherently. The neurological condition is different from the usual state according to her daughter. What elements will you look for in favor of a delirium syndrome? (one or more correct answers)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Fluctuations in unrest","justification":""},{"idx":1,"correct":false,"proposition":"Absences","justification":""},{"idx":2,"correct":true,"proposition":"Language disorders","justification":""},{"idx":3,"correct":true,"proposition":"Amnesia","justification":""},{"idx":4,"correct":true,"proposition":"Visual hallucinations","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-14-qi-12","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" You are diagnosing confusion. What factors do you mention to explain the appearance of delirium syndrome? (one or more correct answers)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Subdural hematoma","justification":""},{"idx":1,"correct":true,"proposition":"Head trauma","justification":""},{"idx":2,"correct":false,"proposition":"Depressive syndrome","justification":""},{"idx":3,"correct":true,"proposition":"Chest pain","justification":""},{"idx":4,"correct":false,"proposition":"Sleep disorders","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-14-qi-13","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" What therapeutic measure(s) are you putting in place regarding this delirium syndrome?","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Continued treatment with benzodiazepine at the same dosage","justification":""},{"idx":1,"correct":false,"proposition":"Melatonin addition","justification":""},{"idx":2,"correct":false,"proposition":"Increased benzodiazepine treatment to cover nycthémère","justification":""},{"idx":3,"correct":true,"proposition":"Daily reminders on temporo-spatial orientation","justification":""},{"idx":4,"correct":true,"proposition":"Analgesic treatment with paracetamol","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-14-qi-14","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" The patient presents with significant false routes to saliva and during the water test. His daughter tells you that her mother had no difficulty swallowing her meals before this fall. What complications can occur because of these swallowing disorders? (one or more correct answers)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Undernutrition","justification":""},{"idx":1,"correct":true,"proposition":"Death","justification":""},{"idx":2,"correct":false,"proposition":"Dysarthria","justification":""},{"idx":3,"correct":true,"proposition":"Pneumonia","justification":""},{"idx":4,"correct":false,"proposition":"Aphasia","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-14-qi-15","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" What measures do you put in place to avoid complications related to swallowing disorders? (one or more correct answers)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Meals in the supine position at 45 °","justification":""},{"idx":1,"correct":true,"proposition":"Meal with head tilted forward","justification":""},{"idx":2,"correct":true,"proposition":"Cold drinks","justification":""},{"idx":3,"correct":true,"proposition":"Drinks","justification":""},{"idx":4,"correct":false,"proposition":"Food with small pieces","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-15-qi-1","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" What semiological elements are present in this patient? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"A fatigability suggestive of diabetic neuropathy","justification":""},{"idx":1,"correct":true,"proposition":"pyramidal syndrome","justification":""},{"idx":2,"correct":false,"proposition":"mowing","justification":""},{"idx":3,"correct":true,"proposition":"peripheral neurological clinical syndrome","justification":""},{"idx":4,"correct":false,"proposition":"myasthenic syndrome","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-15-qi-2","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" This patient has signs and symptoms consistent with diabetic neuropathy. Which ones are compatible with this diagnosis? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"  Very lively and diffused patellar tendon reflexes","justification":""},{"idx":1,"correct":true,"proposition":"Normal tendon reflexes in the upper limbs","justification":""},{"idx":2,"correct":true,"proposition":"Abolished Achileo tendon reflexes","justification":""},{"idx":3,"correct":true,"proposition":"Hypoaesthesia of both feet","justification":""},{"idx":4,"correct":false,"proposition":"Unilateral sensory deficit up to the umbilicus","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-15-qi-3","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" To confirm the lesional location that best explains the clinical picture, which additional examination is most relevant? (only one answer expected)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Bone marrow MRI","justification":""},{"idx":1,"correct":false,"proposition":"Electroneuromyogram","justification":""},{"idx":2,"correct":false,"proposition":"Brain MRI","justification":""},{"idx":3,"correct":false,"proposition":"Driving evoked potentials","justification":""},{"idx":4,"correct":false,"proposition":"Spinal scanner","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-15-qi-4","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" You have requested a spinal cord MRI :P the following proposals, which ones are correct? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"This is a coronal cup","justification":""},{"idx":1,"correct":true,"proposition":"An intramedullary hypersignal is observed next to thoracic vertebrae","justification":""},{"idx":2,"correct":true,"proposition":"The intramedullary signal suggests an inflammatory lesion","justification":""},{"idx":3,"correct":true,"proposition":"This is a T2-weighted cut","justification":""},{"idx":4,"correct":false,"proposition":"  There is a mass effect on the spinal cord","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-15-qi-5","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" In the light of the inflammatory involvement of the dorsal marrow in relation to the 5th thoracic vertebra, what additional examinations could confirm the etiology of this central neurological disease? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Brain MRI","justification":""},{"idx":1,"correct":false,"proposition":"Electroneuromyogram","justification":""},{"idx":2,"correct":false,"proposition":"Somesthetic evoked potentials","justification":""},{"idx":3,"correct":true,"proposition":"Microbiological","justification":""},{"idx":4,"correct":false,"proposition":"Serum CRP assay","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-15-qi-6","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" A brain MRI is performed. It is an MRI in axial section weighted in T2 at the subtentorial level and axial FLAIR at the supratentorial level. Which of the following are true? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Abnormal images are visualized in hyposignal","justification":""},{"idx":1,"correct":false,"proposition":"Hypersignals suggest multiple metastatic lesions","justification":""},{"idx":2,"correct":true,"proposition":"At least one subcortical lesion is visualized","justification":""},{"idx":3,"correct":true,"proposition":" At least one periventricular lesion is visualized","justification":""},{"idx":4,"correct":true,"proposition":" The largest lesion, in subtentorial, affects a cerebellar peduncle","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-15-qi-7","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" A study of cerebrospinal fluid was performed. The main results are as follows:P roteinorachia: 0.68 g \/ LCellules: 0 red blood cells; 6 mononuclear cellsGlycorachia: 0.90 g \/ LIndex IgG: 0.92Oligoclonal appearance with at least 9 supernumerary bands of IgG.Regarding this analysis of cerebrospinal fluid, what are the exact answers? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Proteinrachia is normal","justification":""},{"idx":1,"correct":true,"proposition":"There is an intrathecal synthesis of IgG","justification":""},{"idx":2,"correct":false,"proposition":"There are arguments in favor of bacterial meningitis","justification":""},{"idx":3,"correct":true,"proposition":"Elevated glycorachia is compatible with the context of diabetes","justification":""},{"idx":4,"correct":true,"proposition":"Cellularity is compatible with a diagnosis of multiple sclerosis","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-15-qi-8","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" What diagnoses do you retain to explain all the clinical, radiological and biological data in this file? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Intramedullary tumour","justification":""},{"idx":1,"correct":true,"proposition":"Polyneuropathy","justification":""},{"idx":2,"correct":false,"proposition":"Biermer's disease","justification":""},{"idx":3,"correct":true,"proposition":"Multiple sclerosis","justification":""},{"idx":4,"correct":false,"proposition":"Acute polyradiculoneuritis","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-15-qi-9","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" In addition to a picture of polyneuropathy, this patient has multiple sclerosis (MS). You tell him this diagnosis. He asks you questions about MS. Which of the following are true? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"The primary progressive form is more common in the beginning of the disease","justification":""},{"idx":1,"correct":true,"proposition":"MS is more common in Caucasian women","justification":""},{"idx":2,"correct":true,"proposition":"The presence of cognitive disorders, during illness, is common","justification":""},{"idx":3,"correct":false,"proposition":"The association of MS and type I diabetes is linked to chance","justification":""},{"idx":4,"correct":true,"proposition":"The risk of MS in siblings is increased compared to the general population","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-15-qi-10","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" During his medical follow-up, the patient reports a few months later to be constipated. He sometimes needs to empty his bladder in two or three steps. His libido is diminished. Which of the following are true? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"The patient has symptoms of overactive bladder","justification":""},{"idx":1,"correct":true,"proposition":"The post-voiding residue must be measured","justification":""},{"idx":2,"correct":false,"proposition":"You first mention prostatic hypertrophy","justification":""},{"idx":3,"correct":false,"proposition":"The decrease in libido is directly related to his spinal cord damage","justification":""},{"idx":4,"correct":true,"proposition":"Constipation may be related to MS","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-15-qi-11","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" In general, regarding neuroperineal disorders, which proposals are accurate? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Overactive bladder is mainly manifested by voiding emergencies","justification":""},{"idx":1,"correct":false,"proposition":"First-line drug therapy for overactive bladder relies on alpha-blockers","justification":""},{"idx":2,"correct":true,"proposition":"  Dysuria can be confirmed by flowmetry","justification":""},{"idx":3,"correct":true,"proposition":"In case of post-voiding residues, intermittent self-sounding should be preferred.","justification":""},{"idx":4,"correct":true,"proposition":"Both multiple sclerosis and diabetes can impair erectile abilities","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-15-qi-12","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" This patient has primary progressive MS. It has no background treatment. You see him again six months later. He tells you that he has been feeling particularly tired for a few months and that he is << stiff >>. You observe spasticity of the posterior laloge of the right leg. What support do you offer? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"You are initiating corticosteroid therapy with prednisolone","justification":""},{"idx":1,"correct":false,"proposition":"You contraindicate the resumption of physical activity","justification":""},{"idx":2,"correct":true,"proposition":"You are discussing an antispastic treatment (baclofene)","justification":""},{"idx":3,"correct":false,"proposition":"You gradually introduce pregabalin therapy","justification":""},{"idx":4,"correct":true,"proposition":"You prescribe physiotherapy","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-15-qi-13","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" An electroneuromyogram is performed in this patient given the context of diabetes. The results are as follows: normal sensory and motor conduction velocities to all four limbs. The amplitude of the motor and sensory potentials is halved. The tracings in detection are in favor of neurogenic involvement. What syndromic diagnosis do you remember? (only one answer expected)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Axonal involvement","justification":""},{"idx":1,"correct":false,"proposition":"Demyelinating involvement","justification":""},{"idx":2,"correct":false,"proposition":"Myogenic involvement","justification":""},{"idx":3,"correct":false,"proposition":"Motor plate involvement","justification":""},{"idx":4,"correct":false,"proposition":"Anterior horn involvement","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-15-qi-14","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" What medico-social measures should be put in place for this patient? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"MDPH file for applying for a mobility inclusion card","justification":""},{"idx":1,"correct":false,"proposition":"Invalidity second category","justification":""},{"idx":2,"correct":true,"proposition":"Application for ALD for MS","justification":""},{"idx":3,"correct":false,"proposition":"MDPH file for allocation of human aids","justification":""},{"idx":4,"correct":false,"proposition":"Outplacement","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-16-qi-1","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" The NFS finds: hemoglobin 10.5 g\/dL, MCV 70 fL, reticulocytes 10 G\/L. What is the most likely diagnosis?","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"non-regenerative microcytic anemia","justification":""},{"idx":1,"correct":false,"proposition":"regenerative microcytic anemia","justification":""},{"idx":2,"correct":false,"proposition":"regenerative macrocytic anemia","justification":""},{"idx":3,"correct":false,"proposition":"non-regenerative macrocytic anemia","justification":""},{"idx":4,"correct":false,"proposition":"normocytic regenerative anemia","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-16-qi-2","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" What proposals can explain this non-regenerative microcytic anemia? (one or more correct answers)","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"chronic hemolysis","justification":""},{"idx":1,"correct":false,"proposition":"Folate deficiency","justification":""},{"idx":2,"correct":true,"proposition":"Iron deficiency","justification":""},{"idx":3,"correct":true,"proposition":"celiac disease","justification":""},{"idx":4,"correct":true,"proposition":"Helicobacter pylori infection","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-16-qi-3","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" By plotting the staturo-weight curve, you notice an absence of weight gain for 3 months, without stature break in this young girl previously having a growth curve on the median in weight and height. What are the plausible diagnostic hypotheses? (one or more correct answers)","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"simple pubertal delay","justification":""},{"idx":1,"correct":false,"proposition":"growth hormone deficiency","justification":""},{"idx":2,"correct":true,"proposition":"celiac disease","justification":""},{"idx":3,"correct":true,"proposition":"Crohn's disease","justification":""},{"idx":4,"correct":false,"proposition":"hypothyroidism","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-16-qi-4","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" During interrogation, the mother finds that her daughter eats little at home and sorts her food. What element(s) is (are) in favor of a restrictive eating disorder?","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"relational impoverishment","justification":""},{"idx":1,"correct":true,"proposition":"physical hyperactivity","justification":""},{"idx":2,"correct":true,"proposition":"Concerns about his weight","justification":""},{"idx":3,"correct":false,"proposition":"Disinterest in schooling","justification":""},{"idx":4,"correct":true,"proposition":"wish to eat << healthy>>","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-16-qi-5","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" School absenteeism is important. The girl says that in addition to fatigue, she often has headaches. What element(s) are you looking for in the interrogation that will make you mention secondary headaches?","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"occurrence with cough","justification":""},{"idx":1,"correct":false,"proposition":"occurred mainly on weekends","justification":""},{"idx":2,"correct":true,"proposition":"always occurred on the same side","justification":""},{"idx":3,"correct":true,"proposition":"morning vomiting","justification":""},{"idx":4,"correct":false,"proposition":"associated abdominal pain","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-16-qi-6","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" The headaches are bifrontal, lasting between 10 minutes and 2 hours, relieved with paracetamol that she has been taking about 2 times a month for more than a year. She is not bothered by noise or light. What can it be? One or more exact proposal(s)?","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"typical migraine without aura","justification":""},{"idx":1,"correct":false,"proposition":"Analgesic abuse","justification":""},{"idx":2,"correct":true,"proposition":"tension headaches","justification":""},{"idx":3,"correct":false,"proposition":"chronic migraine","justification":""},{"idx":4,"correct":false,"proposition":"bilateral frontal sinusitis","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-16-qi-7","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" On clinical examination, you notice a small breast bud with enlargement of the areola, the absence of pubic hair, it is not settled. Regarding pubertal development in this patient, which is the exact proposal(s)?","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Tanner Stadium is S2P0","justification":""},{"idx":1,"correct":false,"proposition":"Tanner stadium is S1P0","justification":""},{"idx":2,"correct":true,"proposition":"Tanner Stadium is S2P1","justification":""},{"idx":3,"correct":false,"proposition":"she has a delayed puberty","justification":""},{"idx":4,"correct":false,"proposition":"She has a thelarche premature","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-16-qi-8","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" In front of these persistent headaches, you have a brain MRI performed, the image of which is here. Which proposal(s) is the exact proposal(s)?","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"legend 1 corresponds to the stem of the pituitary gland","justification":""},{"idx":1,"correct":false,"proposition":"Legend 2 corresponds to the third ventricle","justification":""},{"idx":2,"correct":true,"proposition":"legend 3 corresponds to the corpus callosum","justification":""},{"idx":3,"correct":false,"proposition":"Legend 4 corresponds to the cerebellar vermis","justification":""},{"idx":4,"correct":true,"proposition":"Legend 5 corresponds to the sphenoid sinus","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-16-qi-9","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" Brain MRI is normal. The ingesta evaluated by the dietician are lower than the average energy requirement. What is the average energy requirement of a 12-year-old girl? (only one answer expected)","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"1200 kcal\/d","justification":""},{"idx":1,"correct":false,"proposition":"1700 kcal\/d","justification":""},{"idx":2,"correct":true,"proposition":"2200 kcal\/d","justification":""},{"idx":3,"correct":false,"proposition":"2700 kcal\/d","justification":""},{"idx":4,"correct":false,"proposition":"3200 kcal\/d","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-16-qi-10","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" In front of microcytic anemia and the absence of weight gain, you evoke celiac disease. Which proposal(s) is the exact proposal(s)?","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"you find the child too old to discuss this diagnosis","justification":""},{"idx":1,"correct":true,"proposition":"you prescribe an anti-transglutaminase IgA assay","justification":""},{"idx":2,"correct":false,"proposition":"you prescribe an anti-endomysium IgG test","justification":""},{"idx":3,"correct":false,"proposition":"you prescribe the anti-gliadin IgA test","justification":""},{"idx":4,"correct":false,"proposition":"you are doing a proof treatment excluding gluten","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-16-qi-11","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" The dosage of anti-transglutaminase IgA is not in favor of the diagnosis of celiac disease, you now evoke Crohn's disease.Which element(s) would be the element(s) to look for in favor of this diagnostic hypothesis?","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Arthralgia","justification":""},{"idx":1,"correct":true,"proposition":"oral aphthosis","justification":""},{"idx":2,"correct":false,"proposition":"alopecia","justification":""},{"idx":3,"correct":false,"proposition":"episodes of hematemesis","justification":""},{"idx":4,"correct":true,"proposition":"erythema nodosum","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-16-qi-12","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" What would be the biological element(s) in favor of the diagnosis of Crohn's disease?","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Augmented CRP","justification":""},{"idx":1,"correct":true,"proposition":"hypoalbuminemia","justification":""},{"idx":2,"correct":false,"proposition":"increased fecal elastase","justification":""},{"idx":3,"correct":true,"proposition":"increased fecal calprotectin","justification":""},{"idx":4,"correct":false,"proposition":"positive anti-nuclear factors","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-16-qi-13","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" The diagnosis of Crohn's disease was ruled out in the absence of normal inflammatory syndrome, faecal calprotectin and albuminemia. You finally retain the diagnosis of isolated iron deficiency in front of a ferritinemia at 3 ng \/ mL.What element (s) do you seek at the interrogation to explain this disorder in this patient?","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"presence of menorrhagia","justification":""},{"idx":1,"correct":true,"proposition":"Replacement of meat products with pulses","justification":""},{"idx":2,"correct":false,"proposition":"insufficient consumption of oranges","justification":""},{"idx":3,"correct":false,"proposition":"intensive sports practice","justification":""},{"idx":4,"correct":false,"proposition":"excessive consumption of milk products","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-16-qi-14","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" She reports not consuming any meat products. Regarding martial supplementation, what is (are) the exact proposal(s)?","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"The initial prescription is preferably in injectable form","justification":""},{"idx":1,"correct":true,"proposition":"Treatment may result in black stool staining","justification":""},{"idx":2,"correct":true,"proposition":"It is best to divide the daily dose into 3 doses","justification":""},{"idx":3,"correct":true,"proposition":"A reticulocyte seizure usually occurs around day 10 of treatment","justification":""},{"idx":4,"correct":true,"proposition":"The duration of supplementation will be at least 3 months","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-18-qi-1","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" Which diagnosis is most likely? (only one answer expected)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Acute benzodiazepine poisoning","justification":""},{"idx":1,"correct":false,"proposition":"Acute amphetamine poisoning","justification":""},{"idx":2,"correct":true,"proposition":"Acute opioid poisoning","justification":""},{"idx":3,"correct":false,"proposition":"acute intoxication with antidepressants","justification":""},{"idx":4,"correct":false,"proposition":"acute lithium poisoning","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-18-qi-2","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" Which of the following is more suggestive of opioid poisoning?","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"pupillary examination","justification":""},{"idx":1,"correct":false,"proposition":"the depth of coma","justification":""},{"idx":2,"correct":false,"proposition":"Discovery on public roads","justification":""},{"idx":3,"correct":true,"proposition":"respiratory rate","justification":""},{"idx":4,"correct":false,"proposition":"temperature","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-18-qi-3","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" A coma by opioid overdose is diagnosed. What elements are part of the immediate drug treatment? (one or more correct answers)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Naloxone","justification":""},{"idx":1,"correct":false,"proposition":"Flumazenil","justification":""},{"idx":2,"correct":false,"proposition":"N-acetyl-cysteine","justification":""},{"idx":3,"correct":false,"proposition":"Atropine","justification":""},{"idx":4,"correct":false,"proposition":"Buprenorphine","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-18-qi-4","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" After a bolus of naloxone the patient wakes up, naloxone is kept in continuous infusion for a few hours. He reveals that he had bought 50 mg of methadone hydrochloride on the street where he has been living for 3 days, following his release from prison. He was incarcerated for a robbery. He doesn't understand what happened to him because, before entering prison two years ago, he had been taking 80 mg of methadone a day for several months. He was able to stop this treatment in prison, he says proudly: \"It was not easy, especially with the pain.\" But he admits to having \"plunged\" as soon as he left not having been able to control his desire for products. The health care team finds it a little odd. Which of the following elements of the observation are diagnostic criteria for opioid dependence? (one or more correct answers)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Robberies to obtain the product","justification":""},{"idx":1,"correct":true,"proposition":"Abdominal pain between doses","justification":""},{"idx":2,"correct":false,"proposition":"The episode of overdose","justification":""},{"idx":3,"correct":true,"proposition":"Consumption continues despite negative consequences","justification":""},{"idx":4,"correct":true,"proposition":"Craving","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-18-qi-5","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" To take stock of the social situation of this patient, what needs to be specified? (one or more correct answers)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"nationality","justification":""},{"idx":1,"correct":true,"proposition":"housing conditions","justification":""},{"idx":2,"correct":true,"proposition":"Health coverage","justification":""},{"idx":3,"correct":true,"proposition":"its resources and assistance","justification":""},{"idx":4,"correct":false,"proposition":"criminal record","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-18-qi-6","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" The patient is homeless. What options can be considered to relocate him? (one or more correct answers)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Hospitalization in psychiatry","justification":""},{"idx":1,"correct":false,"proposition":"Hospitalization in addictological follow-up care","justification":""},{"idx":2,"correct":true,"proposition":"Solicitation of a bed halte health care","justification":""},{"idx":3,"correct":false,"proposition":"Solicitation of a nursing home","justification":""},{"idx":4,"correct":true,"proposition":"Solicitation of associative hosting","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-18-qi-7","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" A few weeks later, the patient is housed in a Residential and Social Reintegration Centre (CHRS). He consults in addictology because \"decidedly, with heroin, it does not go anymore! \". He consumes 2 to 3 grams per day in sniffing or more rarely in injection. He went to see a doctor in town who advised him to withdraw or substitute treatment. Suspicious, he wants a second opinion on the resumption of methadone hydrochloride. Which of the following statements are true? (one or more correct answers)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"It is too risky given the history of overdose","justification":""},{"idx":1,"correct":false,"proposition":"It should be avoided in favor of clonidine withdrawal","justification":""},{"idx":2,"correct":true,"proposition":"It is possible with psychosocial support","justification":""},{"idx":3,"correct":false,"proposition":"It can be initiated by the town doctor","justification":""},{"idx":4,"correct":true,"proposition":"It is part of an overall risk reduction strategy","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-18-qi-8","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" The patient now lives with a 23-year-old woman, with whom he has been shopping for three months. She occasionally uses heroin sniffing and does not think she needs treatment. She regularly visits a centre where she is given information on the risk of overdose. Which of the following are appropriate risk and harm reduction strategies in this context? (one or more correct answers)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Condom distribution","justification":""},{"idx":1,"correct":true,"proposition":"The realization of serologies HIV, HVB, HVC","justification":""},{"idx":2,"correct":true,"proposition":"Recovery of used consumer equipment","justification":""},{"idx":3,"correct":true,"proposition":"Distribution of sterile syringes","justification":""},{"idx":4,"correct":false,"proposition":"Testing of products consumed","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-18-qi-9","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" The patient has been stabilized for 2 years by treatment with 80 mg of methadone hydrochloride per day. It is his attending physician who reproduces. Last week, he was on vacation and the patient had to deal with a replacement. He was questioned about his drinking, particularly alcohol and tobacco. The patient admitted to regularly drinking two to three beers every night. In order to reduce his cravings for alcohol, the patient asks if he could benefit from treatment like one of his friends who has managed to be weaned. What are the two molecules that could have been prescribed to his friend to help him reduce alcohol consumption?","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Nalmefene","justification":""},{"idx":1,"correct":false,"proposition":"Acamprosate","justification":""},{"idx":2,"correct":true,"proposition":"Baclofen","justification":""},{"idx":3,"correct":false,"proposition":"Naltrexone","justification":""},{"idx":4,"correct":false,"proposition":"Disulfiram","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-18-qi-10","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" The patient recalls that his friend received nalmefene treatment; He therefore wishes to obtain some. The patient's general practitioner's substitute explains the incompatibility of nalmefene with methadone, and offers acamprosate treatment after weaning. At the next consultation, the patient explains to his doctor that he thinks the replacement \"is in cahoots with the pharmaceutical industry\". He noted certain clues that support his idea. \"He would have done better to help me quit smoking,\" he told his doctor. He says he has smoked two packs a day for 10 years. He only supports cigarettes that he makes himself – \"It's safer,\" he says – and also the electronic cigarette. Which of the following signs of tobacco addiction is most severe? (only one answer expected)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"The need to smoke several times a day","justification":""},{"idx":1,"correct":false,"proposition":"Continued consumption despite negative consequences","justification":""},{"idx":2,"correct":true,"proposition":"Smoking your first cigarette when you wake up","justification":""},{"idx":3,"correct":false,"proposition":"Smoking rolled cigarettes","justification":""},{"idx":4,"correct":false,"proposition":"Denial of his smoking problem","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-18-qi-11","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" The patient is severely addicted to tobacco. He agrees to a treatment. Which treatments have a marketing authorization in this indication? (one or more correct answers)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Nicotine replacement by patch","justification":""},{"idx":1,"correct":true,"proposition":"nicotine replacement by gum","justification":""},{"idx":2,"correct":true,"proposition":"varenicline","justification":""},{"idx":3,"correct":false,"proposition":"Baclofen","justification":""},{"idx":4,"correct":false,"proposition":"e-cigarettes","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-18-qi-12","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" Two years later, the patient presented to the emergency room of the hospital because he was not feeling well. He has now been living alone for several months. He has not resumed heroin and is still taking methadone hydrochloride treatment. His partner left him because she could no longer stand his << laziness >> and his lack of motivation to do the markets. She also blamed him for his lack of emotions. He is not well, according to him, since a doctor finally acceded to his request for nalmefene, which he did not support. He often repeats \"evil is not fun\" with a knowing tune and sometimes fabricates new words. He doesn't see anyone anymore. He has trouble washing. Which psychiatric syndrome dominates this clinical picture? (only one answer expected)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"A depressive syndrome","justification":""},{"idx":1,"correct":false,"proposition":"Korsakoff's syndrome","justification":""},{"idx":2,"correct":true,"proposition":"A negative syndrome in schizophrenia","justification":""},{"idx":3,"correct":false,"proposition":"A positive syndrome in schizophrenia","justification":""},{"idx":4,"correct":false,"proposition":"A syndrome of disorganization in the context of schizophrenia","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-18-qi-13","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" The picture is mainly dominated by a negative syndrome suggestive of a schizophrenic disorder. What semiological elements are in favor of this syndrome? (one or more correct answers)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Sadness","justification":""},{"idx":1,"correct":true,"proposition":"Emotional blunting","justification":""},{"idx":2,"correct":true,"proposition":"Aboulia","justification":""},{"idx":3,"correct":true,"proposition":"Social withdrawal","justification":""},{"idx":4,"correct":false,"proposition":"Neologism","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-18-qi-14","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" The patient claims that \"he was very harmed.\" He doesn't know who but he has researched the internet and knows \"now what really happened, and everything is connected\". He pauses in his speech and does not finish his sentences, but does not wish to say more because one could hear him and take it at him. In front of this clinical picture evolving for more than 6 months and the entire history of the patient we can conclude to a diagnosis of schizophrenia. What elements in favor of this diagnosis are in the observation? (one or more correct answers)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Dams","justification":""},{"idx":1,"correct":true,"proposition":"Delusions","justification":""},{"idx":2,"correct":false,"proposition":"Acoustico-verbal hallucinations","justification":""},{"idx":3,"correct":false,"proposition":"Ideo-affective discordance","justification":""},{"idx":4,"correct":false,"proposition":"Catatonic syndrome","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
-{"_id":"annales-2022-dp-18-qi-15","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" The patient agrees to take treatment. Which of the following proposals apply to the antipsychotic treatment you are going to offer this patient? (one or more correct answers)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"it must be based on a second-generation antipsychotic","justification":""},{"idx":1,"correct":false,"proposition":"It must be combined with an anticholinergic corrector","justification":""},{"idx":2,"correct":false,"proposition":"  It must be prescribed in delayed injectable form","justification":""},{"idx":3,"correct":false,"proposition":"it must have a sedative component","justification":""},{"idx":4,"correct":true,"proposition":"It must be prescribed after analysis of an electrocardiogram","justification":""}],"ts":{"$numberLong":"1665243680997"},"type":"dp"}
+{"_id":"annales-2018-dp-1-qi-1","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"What are the elements (present or to be sought at the interrogation and clinical examination) that can evoke a malignant tumor of the kidney? (one or more correct answers) ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Smoking","justification":"Tobacco is indeed a risk factor for kidney (as well as bladder) cancer."},{"idx":1,"correct":true,"proposition":"Chronic high blood pressure","justification":""},{"idx":2,"correct":false,"proposition":"Long-term calcium channel blocker treatment","justification":""},{"idx":3,"correct":false,"proposition":"A family history of multiple endocrine neoplasia","justification":""},{"idx":4,"correct":true,"proposition":"Low back pain","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-1-qi-2","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"Which exam(s) are you asking for as a first line? ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Urinary cytology with pathological examination","justification":"It is indeed a first-line examination"},{"idx":1,"correct":true,"proposition":"Cytobacteriological examination of urine","justification":""},{"idx":2,"correct":false,"proposition":"Serum erythropoietin assay","justification":""},{"idx":3,"correct":true,"proposition":"Abdominopelvic CT scan with and without contrast injection","justification":""},{"idx":4,"correct":false,"proposition":"Ultrasound-guided puncture of the mass","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-1-qi-3","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"On the cut shown below, what are the true propositions?  (one or more correct answers) ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"This is an abdominal CT scan with injection","justification":""},{"idx":1,"correct":false,"proposition":"This is a coronal cup","justification":"Axial cut"},{"idx":2,"correct":false,"proposition":"Structure number 1 is the inferior vena cava","justification":"Aorta"},{"idx":3,"correct":true,"proposition":"The cut passes through the third duodenum","justification":""},{"idx":3,"correct":false,"proposition":"The number 2 corresponds to the inferior mesenteric artery","justification":"superior"}],"type":"dp"}
+{"_id":"annales-2018-dp-1-qi-4","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"What are the real propositions? (one or more correct answers) ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The patient must receive red blood cells","justification":""},{"idx":1,"correct":false,"proposition":"The patient must receive platelet pellets","justification":""},{"idx":2,"correct":false,"proposition":"In case of transfusion of red blood cells, you would prescribe O-negative pellets","justification":""},{"idx":3,"correct":false,"proposition":"A search result for irregular agglutinins less than 48 h old must be available","justification":""},{"idx":4,"correct":false,"proposition":"Since 2003, there has been no risk of transmission of infectious pathogens through red blood cell transfusion","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-1-qi-5","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"What is the real proposal(s)? ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"This is acute renal failure","justification":""},{"idx":1,"correct":false,"proposition":"The glomerular filtration rate must be recalculated","justification":""},{"idx":2,"correct":false,"proposition":"An obstacle on the contralateral kidney is likely","justification":""},{"idx":3,"correct":true,"proposition":"It may be functional renal failure","justification":""},{"idx":4,"correct":true,"proposition":"An ionogram should be prescribed on a urine sample","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-1-qi-6","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"What are the exact proposals? (one or more correct answers) ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"He has moderate chronic renal failure","justification":""},{"idx":1,"correct":true,"proposition":"His antihypertensive treatment must include an inhibitor of the renin-angiotensin system","justification":""},{"idx":2,"correct":false,"proposition":"The LDL cholesterol target to be achieved is 1.3 g\/L","justification":""},{"idx":3,"correct":false,"proposition":"He must follow a diet containing no more than 1.5 g\/kg of protein weight","justification":""},{"idx":4,"correct":false,"proposition":"It is necessary to advocate a diet low in fast sugars","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-1-qi-7","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"What risk(s) does he run? ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Gradual decrease in diuresis","justification":""},{"idx":1,"correct":true,"proposition":"Increased cardiovascular risk","justification":""},{"idx":2,"correct":true,"proposition":"Hyperphosphoremia","justification":""},{"idx":3,"correct":true,"proposition":"Erectile dysfunction","justification":""},{"idx":4,"correct":true,"proposition":"Contralateral kidney cancer","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-1-qi-8","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"What is the true answer(s)? ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"The ALD file is completed by the patient and validated by the medical specialist","justification":""},{"idx":1,"correct":true,"proposition":"The attending physician must specify in the request the protocol of care envisaged including treatments, examinations and consultations","justification":""},{"idx":2,"correct":true,"proposition":"The care protocol must be validated by the medical officer of the Health Insurance","justification":""},{"idx":3,"correct":false,"proposition":"In case of coverage in ALD, remains the responsibility of the patient only the co-payment","justification":""},{"idx":4,"correct":false,"proposition":"The third-party payer is the part of the care paid by the insured whether or not he is registered in ALD","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-1-qi-9","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"What is your interpretation of the electrocardiogram below? ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Sinus rhythm","justification":""},{"idx":1,"correct":false,"proposition":"Sino-auricular block","justification":""},{"idx":2,"correct":false,"proposition":"T-waves suggestive of hyperkalemia","justification":""},{"idx":3,"correct":false,"proposition":"Expanded QRS Complexes","justification":""},{"idx":4,"correct":true,"proposition":"Left ventricular hypertrophy","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-1-qi-10","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"To reduce edematous syndrome, what do you recommend at this stage? (one or more correct answers) ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"A low-salt diet (less than 6 g\/d)","justification":""},{"idx":1,"correct":false,"proposition":"Water restriction","justification":""},{"idx":2,"correct":true,"proposition":"A loop diuretic (furosemide)","justification":""},{"idx":3,"correct":false,"proposition":"A thiazide diuretic (hydrochlorothiazide)","justification":""},{"idx":4,"correct":false,"proposition":"Blood ultrafiltration (start of hemodialysis)","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-1-qi-11","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"What are the possible cause(s) in the context of the new biological abnormality observed? ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Excessive calcium intake","justification":""},{"idx":1,"correct":false,"proposition":"Taking furosemide","justification":""},{"idx":2,"correct":true,"proposition":"Chronic renal failure","justification":"This is a POSSIBLE (but rare) cause of hypercalcemia by tertiary hyperparathyroidism, one really needs to read the statements carefully and take them to the first degree. It should be remembered, however, that chronic renal failure is mainly a source of hypocalcaemia."},{"idx":3,"correct":false,"proposition":"Secondary hyperparathyroidism","justification":"Normal serum calcium"},{"idx":4,"correct":true,"proposition":"Bone metastases from kidney cancer","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-1-qi-12","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"What additional examination(s) do you recommend to explore this biological anomaly? ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Ionized serum calcium","justification":""},{"idx":1,"correct":false,"proposition":"Test de PAK","justification":""},{"idx":2,"correct":true,"proposition":"PTH assay","justification":""},{"idx":3,"correct":false,"proposition":"PTHrp assay","justification":""},{"idx":4,"correct":true,"proposition":"Bone scintigraphy","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-1-qi-13","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"Which proposals are correct? (one or more correct answers) ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Metastatic cancer is a contraindication to dialysis","justification":""},{"idx":1,"correct":false,"proposition":"Haemodialysis confers survival advantage over peritoneal dialysis","justification":""},{"idx":2,"correct":false,"proposition":"The preparation of an arteriovenous fistula (AVF) is contraindicated given the prognosis","justification":""},{"idx":3,"correct":true,"proposition":"A tunneled central venous catheter may be placed to initiate hemodialysis","justification":""},{"idx":4,"correct":false,"proposition":"A transplant from a cadaveric donor must be discussed","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-1-qi-14","context":"A 54-year-old man, a long-term smoker who has been hypertensive for 12 years (calcium channel blocker treatment), consults his attending physician for an isolated episode of total gross hematuria, without a clot. His other history has been an appendectomy in childhood. The blood count is as follows: Hb 10.4 g\/dL (MCV 78 µm3), GB 8 G\/L, blisters 247 G\/L. Creatinine is 110 µmol\/L (estimated glomerular filtration rate of 65 ml\/min\/1.73 m2). A renal ultrasound showed a hyperechoic mass of 7 cm on the right kidney. ","enonce":"In general, regarding living donors, what are the real proposals? (one or more correct answers) ","item":"annales-2018-dp-1","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Only people with a genetic link to the recipient can be donors","justification":""},{"idx":1,"correct":true,"proposition":"Transplantation can be done in incompatible ABO condition","justification":""},{"idx":2,"correct":false,"proposition":"Rhesus compatibility must be respected","justification":""},{"idx":3,"correct":false,"proposition":"HLA incompatibility between donor and recipient is a formal contraindication","justification":""},{"idx":4,"correct":false,"proposition":"The donor is remunerated on a basis proportional to the recipient's waiting time","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-2-qi-1","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"What additional examination(s) do you prescribe in early pregnancy? ","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Cervico-uterine smear","justification":""},{"idx":1,"correct":true,"proposition":"Hbs antigen","justification":""},{"idx":2,"correct":true,"proposition":"Fasting blood glucose","justification":""},{"idx":3,"correct":false,"proposition":"Pulmonary function tests","justification":""},{"idx":4,"correct":true,"proposition":"Cytobacteriological examination of urine","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-2-qi-2","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"Regarding trisomy 21 screening in this case, what is (are) the exact proposal(s)? ","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Nuchal translucency measurement is performed on an axial section of the fetus","justification":""},{"idx":1,"correct":true,"proposition":"Combined first trimester screening takes into account gestational age","justification":""},{"idx":2,"correct":false,"proposition":"Integrated sequential screening of the second trimester is not possible due to Turner syndrome","justification":""},{"idx":3,"correct":false,"proposition":"The patient's age is taken into account for the calculation of the combined risk of the first trimester","justification":""},{"idx":4,"correct":false,"proposition":"Total hCG is considered for combined first trimester screening","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-2-qi-3","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"What is the exact proposal(s)? ","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"This is a toxoplasma seroconversion","justification":""},{"idx":1,"correct":true,"proposition":"The initiation of treatment with spiramycin is lawful","justification":""},{"idx":2,"correct":true,"proposition":"Amniocentesis should be offered at least 4 weeks after the expected date of seroconversion","justification":""},{"idx":3,"correct":false,"proposition":"IgG avidity test is indicated","justification":""},{"idx":4,"correct":false,"proposition":"Cross-reaction with other infectious agents may explain this serological result","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-2-qi-4","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"You start treatment with spiramycin. Regarding this molecule and the pharmacological class to which it belongs, which is (are) the exact proposal(s)?  What is the exact proposal(s)? B. The genome of ","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Spiramycin has a parasiticidal action on Toxoplasma gondii","justification":"Macrolides are parasitostatic"},{"idx":1,"correct":true,"proposition":"Spiramycin acts by inhibition of bacterial proteins by binding to a ribosomal subunit"},{"idx":2,"correct":true,"proposition":"Spiramycin is active on Mycoplasma hominis"},{"idx":3,"correct":true,"proposition":"P. aeruginosa is naturally resistant"},{"idx":4,"correct":true,"proposition":"The therapeutic class is used in the treatment of pertussis"}],"type":"dp"}
+{"_id":"annales-2018-dp-2-qi-5","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"You decide to look for mother-to-fetal transmission of T. gondii. What are the exact proposal(s)?","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"You perform a choriocentesis","justification":""},{"idx":1,"correct":true,"proposition":"The genome is sought in amniotic fluid","justification":"By amniocentesis"},{"idx":2,"correct":false,"proposition":"A search for specific IgG is performed on fetal blood","justification":""},{"idx":3,"correct":false,"proposition":"Chorioretinitis should be tested by fetal ultrasound","justification":""},{"idx":4,"correct":false,"proposition":"Anemia should be sought by measuring brain velocities in Doppler","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-2-qi-6","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"You perform an amniocentesis. The same evening, the patient comes to see you for abdominal pain that has lasted for several hours. There is no vaginal discharge and no bleeding. The patient is apyretic and normotensive. The cervix is shortened to the vaginal touch and measures 18mm. What treatment(s) do you introduce? ","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Betamethasone","justification":""},{"idx":1,"correct":true,"proposition":"Continuation of spiramycin treatment","justification":""},{"idx":2,"correct":false,"proposition":"Indomethacin","justification":""},{"idx":3,"correct":true,"proposition":"Atosiban","justification":""},{"idx":4,"correct":true,"proposition":"Magnesium sulphate","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-2-qi-7","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"After 24 hours of hospitalization, the patient notices losses of smelly fluid through the vagina. Uterine contractions have resumed and are painful. The temperature is 39.3°C.  She gets chills. Cardiotocographic recording shows fetal tachycardia and 5 uterine contractions every 10 minutes. What is the most likely diagnosis?","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Acute appendicitis","justification":""},{"idx":1,"correct":false,"proposition":"Acute pyelonephritis","justification":""},{"idx":2,"correct":false,"proposition":"Listeriosis","justification":""},{"idx":3,"correct":false,"proposition":"Toxoplasma sepsis","justification":""},{"idx":4,"correct":true,"proposition":"Chorioamnionitis","justification":"Most likely given the context (amniocentesis, fever)."}],"type":"dp"}
+{"_id":"annales-2018-dp-2-qi-8","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"In front of this chorioamnionitis and the presence of fetal heart rhythm abnormalities, you perform an emergency caesarean section under general anesthesia. As soon as the child is extracted, heavy bleeding of endouterine origin is observed. Manual delivery of the placenta is performed and the hysterotomy is sutured. The uterus remains soft and significant bleeding persists externalized vaginally despite the infusion of oxytocics. The patient is hemodynamically stable. What therapeutic option(s) can be used in this situation? ","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Mifepristone infusion","justification":""},{"idx":1,"correct":true,"proposition":"Ligation of uterine arteries","justification":""},{"idx":2,"correct":false,"proposition":"Methotrexate infusion","justification":""},{"idx":3,"correct":true,"proposition":"Sulprostone infusion","justification":""},{"idx":4,"correct":false,"proposition":"Ligation of the external iliac arteries","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-2-qi-9","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"An infusion of sulprostone is initiated. One Hemocue reveals a hemoglobin level of 6 g\/dL. Blood loss is estimated at 1500 ml. Blood pressure is 100\/60 and heart rate is 130 beats per minute (bpm). A biological assessment is carried out. The anesthesiologist orders labile blood products in a life-threatening emergency. After 30 minutes, the bleeding seems to dry up and the results of the laboratory workup are available: Leukocytes 15.2 G\/L. Platelets 70 G\/L. Haemoglobin 5.7 g\/dL. Prothrombin level 60%. Activated cephalin time 32\/30. Fibrinogenemia 0.5 g\/L. D-Dimers elevated. Which of the elements of this assessment is included in the definition of biological disseminated intravascular coagulation (DIC)? ","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Platelets","justification":""},{"idx":1,"correct":false,"proposition":"Leukocytes","justification":""},{"idx":2,"correct":true,"proposition":"Fibrinogen","justification":""},{"idx":3,"correct":true,"proposition":"D-dimer","justification":""},{"idx":4,"correct":false,"proposition":"Haemoglobin","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-2-qi-10","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"Taking into account the biological assessment, a transfusion of a platelet concentrate and 4 red blood cells is performed as well as an injection of 1.5 g of fibrinogen. One hour after birth, the bleeding has now dried up. The patient is monitored for 3 hours in the recovery room before being transferred to intensive care. The caesarean section allowed the birth of a girl weighing 790 grams who was immediately supported by the neonatal team. The clinical examination at 5 minutes of life is as follows: respiratory rate 70 \/ minute, intercostal and suprasternal pull, intense xyphoidian funnel, moderate fluttering of the wings of the nose, expiratory whining with the stethoscope, paradoxical respiration, generalized cyanosis, hypotonia, oxygen requirements (02) at 50% to maintain a 90% saturometry. About the neonatal clinical condition, which is the exact proposal(s)?","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"This is transient respiratory distress","justification":""},{"idx":1,"correct":false,"proposition":"The Apgar score is not interpretable in case of prematurity","justification":""},{"idx":2,"correct":true,"proposition":"This child's oxygen needs are a sign of severity","justification":""},{"idx":3,"correct":true,"proposition":"Silverman's score is 8","justification":""},{"idx":4,"correct":false,"proposition":"Generalized cyanosis is in favor of anemia of the newborn","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-2-qi-11","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"The child's respiratory condition improves but after 36 hours in neonatology, his condition deteriorates sharply. A chest X-ray is performed. What diagnosis(s) can you retain from the interpretation of this shot?","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Left fluid pleural effusion","justification":""},{"idx":1,"correct":false,"proposition":"Left retrocardiac atelectasis","justification":""},{"idx":2,"correct":true,"proposition":"Right pneumothorax","justification":""},{"idx":3,"correct":false,"proposition":"Left diaphragmatic hernia","justification":""},{"idx":4,"correct":false,"proposition":"Right pneumoperitoneum","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-2-qi-12","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"You diagnose a right pneumothorax. After exsufflation of the latter, the respiratory condition of the child improves markedly. In addition, at 48 hours of the caesarean section, the mother complains of chest pain. In this patient, which pathology(s) should you eliminate first? ","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Acute cardiogenic edema","justification":""},{"idx":1,"correct":true,"proposition":"Aortic dissection","justification":""},{"idx":2,"correct":false,"proposition":"Bacterial pneumonitis","justification":""},{"idx":3,"correct":false,"proposition":"Pericarditis","justification":""},{"idx":4,"correct":true,"proposition":"Pulmonary embolism","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-2-qi-13","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"In addition to the chest doubt, the patient complains of dyspnea. Blood pressure is at 130\/70 mmHg. The pulses are symmetrical. The temperature is 37.5 ° C.  You decide to immediately perform an emergency pulmonary angiography. What anomaly(s) do you identify on these 3 shots? ","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Dilation of the left ventricle","justification":""},{"idx":1,"correct":false,"proposition":"Ascending aorta dissection","justification":""},{"idx":2,"correct":true,"proposition":"Acute pulmonary heart","justification":""},{"idx":3,"correct":true,"proposition":"Bilateral pulmonary embolism","justification":""},{"idx":4,"correct":false,"proposition":"Pneumomediastinum","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-2-qi-14","context":"For her first pregnancy, you are following a 24-year-old patient with Turner syndrome (formula 45, X). Due to ovarian failure, her pregnancy was achieved by egg donation. The maternal pregestational assessment was performed and did not contraindicate pregnancy. She measures 1m46 and weighs 74 kg, or a body mass index (BMI) of 35 kg \/ m2 She is currently at 11 weeks of amenorrhea plus 2 days (11 + 2 SA). His history includes: laparoscopic appendectomy, episodic asthma without background treatment, several upper urinary tract infections. ","enonce":"A pulmonary embolism is diagnosed. Heparin therapy at curative dose is introduced. The patient is transferred back to the maternity ward after 48 hours. She wants to breastfeed but worries because she has cold sores. What do you say about breastfeeding? (one or more correct answers) ","item":"annales-2018-dp-2","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Breastfeeding is possible despite heparin treatment","justification":""},{"idx":1,"correct":false,"proposition":"Breastfeeding is not possible, as the child is premature","justification":""},{"idx":2,"correct":false,"proposition":"Herpes labialis contraindicates breastfeeding","justification":""},{"idx":3,"correct":false,"proposition":"She won't have a milk rush due to Turner syndrome","justification":""},{"idx":4,"correct":false,"proposition":"Breastfeeding is not recommended in this patient due to complications of childbirth","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-3-qi-1","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"For the evaluation of dependence, which of the following proposals, which corresponds to an instrumental function? ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Wash","justification":""},{"idx":1,"correct":true,"proposition":"Shopping","justification":""},{"idx":2,"correct":true,"proposition":"Prepare a meal","justification":""},{"idx":3,"correct":false,"proposition":"Dress","justification":""},{"idx":4,"correct":true,"proposition":"Manage your medications","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-3-qi-2","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"A dependent patient can benefit from the personalized autonomy allowance.  Select the right proposal(s) from the following: ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"It concerns patients over 60 years of age","justification":""},{"idx":1,"correct":false,"proposition":"It is assigned to GIR 5 and 6 according to the AGGIR grid","justification":""},{"idx":2,"correct":true,"proposition":"Its amount depends on the level of dependency","justification":""},{"idx":3,"correct":true,"proposition":"Its amount depends on individual income","justification":""},{"idx":4,"correct":true,"proposition":"It also concerns patients in nursing homes","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-3-qi-3","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"The IADL (Instrumental activities of daily living) scale is 6\/8. The patient is not very informative, but she says she is tired as soon as she tries to make an effort. She comes accompanied by her daughter who finds her mother sad, and who mentions the progressive appearance of anterograde memory disorders, forcing her to note the information. She has trouble finding certain objects, or the names of her children that she sometimes confords, which saddens her. A month ago, she got lost in a neighborhood she knew well before, which worried her daughter and justified the consultation. The neurological examination is normal, without pyramidal syndrome or parkinsonism. The MMS is at 23\/30, with a reminder of the 3 words at 2\/3. Regarding the evaluation of recent memory in the neuropsychological assessment, the encoding is normal but the patient has a deficit of free recall well corrected by the indication (reactivity 87.5%). The Front Efficiency Fast Battery (BREF) is 15\/18. You mention a major neurocognitive disorder according to DSM 5. Which of the following criterion(s) are actually part of it? ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Slow progressive evolution","justification":""},{"idx":1,"correct":true,"proposition":"Decline in at least one cognitive domain","justification":""},{"idx":2,"correct":true,"proposition":"Memory impairment","justification":""},{"idx":3,"correct":true,"proposition":"Interference of cognitive impairment with autonomy","justification":""},{"idx":4,"correct":false,"proposition":"Worsening of disorders during confusional episodes","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-3-qi-4","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"Brain MRI shows Fazekas stage III vascular leukopathy, with two lacunar ischemic vascular sequelae, as well as Scheltens stage I hippocampal atrophy. The neuropsychological assessment shows a visuo-verbal impairment of subcortical profile, and a dyseexecutive syndrome. Which of the following diagnose(s) do you mention? ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Alzheimer's disease","justification":""},{"idx":1,"correct":true,"proposition":"Cerebrovascular disease","justification":""},{"idx":2,"correct":false,"proposition":"Chronic hydrocephalus","justification":""},{"idx":3,"correct":true,"proposition":"Depression","justification":""},{"idx":4,"correct":false,"proposition":"Frontotemporal lobar degeneration","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-3-qi-5","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"You are diagnosed with major neurocognitive disorder of cerebrovascular origin and depressive syndrome. Which of the following elements of processing are you starting at this stage?","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Balance of cardiovascular risk factors","justification":""},{"idx":1,"correct":false,"proposition":"Acetylcholine esterase inhibitor","justification":""},{"idx":2,"correct":true,"proposition":"Psychological follow-up","justification":""},{"idx":3,"correct":false,"proposition":"Legal protection","justification":"The patient remains autonomous with an MMS score that does not seem to put her at risk."},{"idx":4,"correct":true,"proposition":"Personalized autonomy allowance","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-3-qi-6","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"The patient is sedentary, weighs 70 kgs for 1.52 m or a body mass index of 30 kg \/ m2. Blood pressure is 133\/65 mmHg, heart rate is 45\/min. Her daughter tells you that the patient always has a slow pulse when she takes her constants at home, between 40 and 50\/min. The systolic pressure index is 1.2. HbA1C 7.9%, albumin 31 g\/l, CRP 2 mg\/L (normal 5), hemoglobin 12 g\/dL. Regarding the cardiovascular risk factors of this patient, what measure(s) are you taking? ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Low-calorie diet","justification":""},{"idx":1,"correct":false,"proposition":"Low carbohydrate diet","justification":""},{"idx":2,"correct":true,"proposition":"High protein diet","justification":""},{"idx":3,"correct":false,"proposition":"Sodium diet","justification":""},{"idx":4,"correct":true,"proposition":"Adapted physical activity","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-3-qi-7","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"Regarding the systolic pressure index (SPI), which proposal(s) is(are) right? ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"It allows the screening of arterial disease obliterans of the lower limbs","justification":""},{"idx":1,"correct":false,"proposition":"Its measurement is contraindicated in case of critical ischemia","justification":""},{"idx":2,"correct":true,"proposition":"It is calculated as the ratio of ankle blood pressure to humeral blood pressure.","justification":""},{"idx":3,"correct":true,"proposition":"An SPI greater than 1.30 reflects incompressible, rigid and calcified arteries","justification":""},{"idx":4,"correct":true,"proposition":"It makes it possible to follow the evolution of arterial disease obliterating the lower limbs","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-3-qi-8","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"The patient also reports three recent falls, while her daughter specifies that she did not fall before. The patient mentions a dizzying sensation during the first fall, fleeting, but evokes above all a clumsiness each time, as when she stumbled into the edge of a sidewalk. ENT explorations carried out in the city are normal. You perform a search for orthostatic hypotension. Choose the right proposal(s) from the following:","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Negative research eliminates orthostatic hypotension","justification":""},{"idx":1,"correct":false,"proposition":"An acceleration of the heart rate > 100\/min evokes dysautonomia","justification":""},{"idx":2,"correct":true,"proposition":"A decrease in systolic blood pressure 20 mmHg at orthostatism confirms the diagnosis","justification":""},{"idx":3,"correct":false,"proposition":"The absence of symptoms at orthostatism rules out the diagnosis","justification":""},{"idx":4,"correct":true,"proposition":"An isolated decrease in diastolic blood pressure of > 1O mmHg at orthostatism confirms the diagnosis","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-3-qi-9","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"You confirm orthostatic hypotension in this patient. Which of the following factors, in the case of this patient, may have contributed to this? ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Non-insulin-dependent diabetes","justification":""},{"idx":1,"correct":false,"proposition":"High blood pressure","justification":""},{"idx":2,"correct":true,"proposition":"Calcium channel blocker","justification":""},{"idx":3,"correct":false,"proposition":"Sedentary lifestyle","justification":""},{"idx":4,"correct":false,"proposition":"Hemoglobin level","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-3-qi-10","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"The systolic pressure index is 1.2.What therapeutic measure(s) in first line do you take regarding this orthostatic hypotension? ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Class 2 venous compression","justification":""},{"idx":1,"correct":false,"proposition":"Addition of midodrine","justification":""},{"idx":2,"correct":false,"proposition":"Addition of fludrocortisone","justification":""},{"idx":3,"correct":false,"proposition":"Discontinuation of antihypertensive therapy","justification":""},{"idx":4,"correct":true,"proposition":"Regular physical activity","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-3-qi-11","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"What abnormality(s) do you notice on this ECG? ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Sinus rhythm","justification":""},{"idx":1,"correct":true,"proposition":"Second degree atrioventricular block","justification":""},{"idx":2,"correct":false,"proposition":"Paroxysmal sinoatrial block","justification":""},{"idx":3,"correct":true,"proposition":"Left axis of QRS","justification":""},{"idx":4,"correct":true,"proposition":"Right branch block","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-3-qi-12","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"In view of the entire file, what anomaly(s) are you looking for on the holter requested by the attending physician? ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Sinus dysfunction","justification":""},{"idx":1,"correct":true,"proposition":"Paroxysmal atrial fibrillation","justification":""},{"idx":2,"correct":false,"proposition":"Paroxysmal ventricular tachycardia","justification":""},{"idx":3,"correct":false,"proposition":"Ischemic heart disease","justification":""},{"idx":4,"correct":true,"proposition":"High-grade atrioventricular block","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-3-qi-13","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"The holter shows sinus dysfunction (high-degree sinoatrial block) and nodal dysfunction (BAV2 Mobitz 2) with long periods of bradycardia between 35 and 40 per minute, without AF. Which treatment(s) do you decide? ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Double chamber pacemaker installation","justification":""},{"idx":1,"correct":false,"proposition":"Discontinuation of calcium channel blocker","justification":"-dipine is not bradycardial (non-cardio-selective)."},{"idx":2,"correct":false,"proposition":"Curative anticoagulant treatment","justification":""},{"idx":3,"correct":false,"proposition":"Amiodarone","justification":""},{"idx":4,"correct":false,"proposition":"Therapeutic abstention and monitoring","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-3-qi-14","context":"You take care of a 91-year-old patient in a day hospital, referred by her doctor and her children, for memory disorders and balance disorders with falls. In his history, you note high blood pressure treated with amlodipine (calcium channel blocker), type 2 diabetes for 10 years treated by diet alone, hypercholesterolemia treated with pravastatin (statin), visual acuity decreased by age-related macular degeneration, hearing loss, right wrist fracture on fall, osteoporosis treated with vitamino D-calcium supplementation. This former English teacher, widowed for 15 years, lives alone in a house without home help. The stove is gas, the patient is cooking, and she hasn't been driving for a year because she didn't feel safe. Shopping has also become more difficult, and her daughter fills her fridge once a week. ","enonce":"Finally, tests show a creatinine clearance of 27 mL\/min. You recover a value a year ago at 29 mL \/ min whose vascular and diabetic origin had been retained. What impact does this information have on your current or future treatment? ","item":"annales-2018-dp-3","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Contraindication to angiotensin-converting enzyme inhibitor therapy","justification":""},{"idx":1,"correct":true,"proposition":"Contraindication to bisphosphonate therapy if indicated","justification":"Car DFG30."},{"idx":2,"correct":false,"proposition":"Contraindication to a high protein diet","justification":""},{"idx":3,"correct":false,"proposition":"Contraindication to treatment with denosumab if indicated","justification":""},{"idx":4,"correct":false,"proposition":"Contraindication to pravastatin","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-4-qi-1","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"This patient consumed 1 glass of whisky per day and 75 cl of wine per day. He has been weaned for 3 months following the discovery of cirrhosis. About cirrhosis, what is the exact proposal(s)?","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Has a histological definition","justification":""},{"idx":1,"correct":true,"proposition":"Is a fibrous scar of the hepatic parenchyma","justification":""},{"idx":2,"correct":false,"proposition":"Is an irreversible disease","justification":""},{"idx":3,"correct":true,"proposition":"May be asymptomatic","justification":""},{"idx":4,"correct":true,"proposition":"Can be diagnosed without liver biopsy","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-4-qi-2","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"The clinical examination is unremarkable. He has no sign of portal hypertension, no sign of severe sepsis. The biological balance shows: Na at 135mmol \/ L, K at 3.7mmol \/ L, CRP at 15mg \/ L, creatinine at 80 μmol \/ L, urea at 6.1 mmol \/ L, Hb at 137g \/ L, platelets at 120G \/ L, PNN at 7.45G \/ L, TP at 43%, TCA at 35\/28, AST at 69Ul \/ L, ALT at 33IU \/ L, Alkaline phosphatase at 146U \/ L,  gammaGT at 236 IU\/L. The patient has abundant daily sputum. In front of dyspnea, you realize the arterial blood gases in ambient air: pH at 7.49, PCO2 at 29mmHg, P02 at 75mmHg, HCO3- at 22mmol. What is your interpretation (only one answer)? ","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Compensated metabolic alkalosis","justification":""},{"idx":1,"correct":false,"proposition":"Decompensated metabolic alkalosis","justification":""},{"idx":2,"correct":false,"proposition":"Decompensated mixed alkalosis","justification":""},{"idx":3,"correct":false,"proposition":"Compensated respiratory alkalosis","justification":""},{"idx":4,"correct":true,"proposition":"Decompensated respiratory alkalosis","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-4-qi-3","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"Chest X-ray shows a left basal opacity. You complete by performing a chest scan. What is the real proposal(s)?","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The mark A corresponds to the arch of the aorta","justification":""},{"idx":1,"correct":false,"proposition":"Benchmark B corresponds to the trunk of the pulmonary artery","justification":""},{"idx":2,"correct":false,"proposition":"The C mark corresponds to the left stem bronchus","justification":""},{"idx":3,"correct":false,"proposition":"Coordinate system D corresponds to the esophagus","justification":""},{"idx":4,"correct":false,"proposition":"The mark E corresponds to the inferior vena cava","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-4-qi-4","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"The mediastinal window shows lymphadenopathy. Here is a chest window computed tomography section. What do you observe? (one or more correct answers) ","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Micronodules","justification":""},{"idx":1,"correct":false,"proposition":"Intralobular cross-linking","justification":""},{"idx":2,"correct":false,"proposition":"From the honeycomb","justification":""},{"idx":3,"correct":false,"proposition":"An aspect in << release of balloons>>","justification":""},{"idx":4,"correct":true,"proposition":"A nodule of about 3 cm","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-4-qi-5","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"What diagnostic hypothesis(s) can explain the entire thoracic clinico-radiological picture? ","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Diffuse bronchiolitis","justification":""},{"idx":1,"correct":false,"proposition":"Stage I pulmonary carcinoma","justification":""},{"idx":2,"correct":false,"proposition":"Carcinomatous lymphangitis","justification":""},{"idx":3,"correct":false,"proposition":"Hypersensitivity pneumonitis","justification":""},{"idx":4,"correct":true,"proposition":"Pulmonary tuberculosis","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-4-qi-6","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"You suspect a tuberculosis miliary. How do you make the first-line diagnosis (one or more correct answers)? ","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Examination of sputum addressed in mycobacteriology for acid-alcohol-resistant bacilli (BAAR)","justification":""},{"idx":1,"correct":true,"proposition":"Cytobacteriological examination of urine addressed in mycobacteriology for acid-alcohol-resistant bacilli (RBBA)","justification":""},{"idx":2,"correct":false,"proposition":"Bronchoalveolar lavage addressed in mycobacteriology in search of acid-alcohol-resistant bacilli (BAAR)","justification":"Not in the first intention. It is done if the patient does not spit, the gastric tubing is negative, and the supiscion is diagnosis is strong."},{"idx":3,"correct":false,"proposition":"Lymph node puncture by bronchial endoscopic ultrasound addressed in mycobacteriology in search of acid-alcohol-resistant bacilli (BAAR)","justification":""},{"idx":4,"correct":false,"proposition":"Transthoracic puncture guided by CT scan of the mass addressed in mycobacteriology in search of acid-alcohol-resistant bacilli (BAAR)","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-4-qi-7","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"Sputum analysis shows 10 to 100 BAAR\/field live. You retain the diagnosis of miliary tuberculosis to M. tuberculosis. Which examination(s) should be taken into consideration in your pre-therapeutic assessment? ","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Hepatic test","justification":""},{"idx":1,"correct":true,"proposition":"Creatinine","justification":""},{"idx":2,"correct":true,"proposition":"Ophthalmological examination","justification":""},{"idx":3,"correct":false,"proposition":"Pulmonary function testing","justification":""},{"idx":4,"correct":true,"proposition":"HIV serology","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-4-qi-8","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"What anti-TB treatment(s) will you offer this patient as a first-line treatment? ","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Isoniazid (INH)","justification":""},{"idx":1,"correct":false,"proposition":"Streptomycin","justification":""},{"idx":2,"correct":true,"proposition":"Ethambutol (EMB)","justification":""},{"idx":3,"correct":true,"proposition":"Rifampicin (RMP)","justification":""},{"idx":4,"correct":false,"proposition":"Pyrazinamide (PZA)","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-4-qi-9","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"What is (are) the other measure(s) to put in place in this patient? ","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Inhaled corticosteroid therapy","justification":""},{"idx":1,"correct":true,"proposition":"Request 100% coverage for long-term illness","justification":""},{"idx":2,"correct":true,"proposition":"Respiratory isolation","justification":""},{"idx":3,"correct":true,"proposition":"Anonymous notification to the Regional Health Agency (ARS)","justification":""},{"idx":4,"correct":false,"proposition":"Anonymous notification to the Tuberculosis Centre (CLAT) of the department of the case of domicile","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-4-qi-10","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"You start a combination of isoniazid, rifampicin and ethambutol. After 2 weeks, the patient leaves the hospital. You follow him every month in consultation, but you have doubts about the patient's compliance with the treatment. How do you monitor its observance? (one or more correct answers) ","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Staining of teeth","justification":""},{"idx":1,"correct":true,"proposition":"Urine staining","justification":""},{"idx":2,"correct":false,"proposition":"Determination of uricemia","justification":"The patient is not taking pyrazinamide."},{"idx":3,"correct":false,"proposition":"Determination of transaminases","justification":""},{"idx":4,"correct":false,"proposition":"Color vision","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-4-qi-11","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"The patient wonders about the role of his profession in the occurrence of tuberculosis. You consult the table of occupational diseases 40b of the general scheme. This table indicates that (one or more correct answers):","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Your patient's condition is in the list of conditions that can be recognized as an occupational disease","justification":""},{"idx":1,"correct":false,"proposition":"The period of care indicates that the patient must have been exposed for more than 6 months to be recognized as an occupational disease","justification":""},{"idx":2,"correct":true,"proposition":"Your patient's profession is in the exhaustive list of works","justification":""},{"idx":3,"correct":false,"proposition":"The patient can be directly recognized as an occupational disease","justification":""},{"idx":4,"correct":true,"proposition":"The application for recognition as an occupational disease must go before the regional committee for the recognition of occupational diseases","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-4-qi-12","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"The patient asks you what advantage he can benefit from in case of a possible recognition as an occupational disease? (one or more correct answers) ","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"An impossibility of dismissal","justification":""},{"idx":1,"correct":false,"proposition":"Compensation for damage to possible secondary family cases","justification":""},{"idx":2,"correct":false,"proposition":"Better compensation for sick leave","justification":""},{"idx":3,"correct":true,"proposition":"100% coverage of treatments","justification":""},{"idx":4,"correct":true,"proposition":"A pension based on last salary and disability rate","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-4-qi-13","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"What is your interpretation of these pulmonary function tests (one or more correct answers)? ","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Obstructive ventilatory syndrome","justification":""},{"idx":1,"correct":false,"proposition":"Restrictive ventilatory syndrome","justification":""},{"idx":2,"correct":false,"proposition":"Chest distension"},{"idx":3,"correct":true,"proposition":"Carbon monoxide diffusion disorder","justification":""},{"idx":4,"correct":false,"proposition":"Normal functional explorations","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-4-qi-14","context":"Patient aged 63 years, active smoker 45 pack-years, consults for an alteration of the general condition with a weight loss of 8 Kg in 4 months. He has been retired for 3 years while he was a nurse in an infectious disease department in a public hospital in France. There is no notion of atopic terrain. The patient does not take any treatment. He has anorexia, intense fatigue, a slight fever fluctuating around 38 ° C appeared for 4 weeks and dyspnea stage II CKD. ","enonce":"The chest computed tomography no longer finds the abnormalities previously described and the pulmonary parenchyma appears normal. On the other hand, there is abnormal dilation of the pulmonary arteries. You suspect pulmonary hypertension associated with portal hypertension. In which group of the International Clinical Classification of Pulmonary Hypertension will you classify this patient? ","item":"annales-2018-dp-4","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Group 1","justification":""},{"idx":1,"correct":false,"proposition":"Group 2","justification":""},{"idx":2,"correct":false,"proposition":"Group 3","justification":""},{"idx":3,"correct":false,"proposition":"Group 4","justification":""},{"idx":4,"correct":false,"proposition":"Group 5","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-5-qi-1","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"On the wrist x-rays performed in the emergency room, what is(are) the exact proposal(s)?","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"The radial glenoid is anteverted","justification":""},{"idx":1,"correct":true,"proposition":"The radius fracture is extra-articular","justification":""},{"idx":2,"correct":false,"proposition":"The bistyloid line is verticalized","justification":""},{"idx":3,"correct":false,"proposition":"There is an excess length of the radius compared to the ulna","justification":""},{"idx":4,"correct":true,"proposition":"The fracture of the radius has a metaphyseal site","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-5-qi-2","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"On clinical examination, what element(s) do you find if the radius fracture is uncomplicated?","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"A medial bayonet face deformation","justification":""},{"idx":1,"correct":true,"proposition":"A deformation on the back of a fork","justification":""},{"idx":2,"correct":false,"proposition":"A hypoesthesia of the pulp of the first 3 fingers","justification":""},{"idx":3,"correct":false,"proposition":"An elective pain of the anatomical snuffbox","justification":""},{"idx":4,"correct":true,"proposition":"A protrusion of the styloid of the ulna","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-5-qi-3","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"During the initial clinical examination, the patient fails to perform active flexion of the interphalangienoe joint of the thumb. What is the exact proposal(s)?","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"This may be due to compression of the median nerve in the wrist.","justification":""},{"idx":1,"correct":true,"proposition":"This must evoke a cause other than the fracture itself.","justification":""},{"idx":2,"correct":false,"proposition":"This may be due to paralysis of the long abductor of the thumb.","justification":""},{"idx":3,"correct":false,"proposition":"This may be due to paralysis of the opponent of the thumb","justification":""},{"idx":4,"correct":true,"proposition":"This may be due to damage to the tendon of the long flexor of the thumb.","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-5-qi-4","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"Which imaging examination(s) prescribed in first line seem to you relevant for his functional impotence of the lower right limb?","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Computed tomography of the pelvis and right hip","justification":""},{"idx":1,"correct":true,"proposition":"X-ray of the front pelvis","justification":""},{"idx":2,"correct":true,"proposition":"X-ray of the right hip in profile","justification":""},{"idx":3,"correct":false,"proposition":"Bone scintigraphy","justification":""},{"idx":4,"correct":false,"proposition":"Angiocomputed tomography of the pelvis and right lower limb","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-5-qi-5","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"In view of the X-ray of the pelvis attached, what is the exact proposal?","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"This is a type 1 fracture according to Garden's classification","justification":""},{"idx":1,"correct":false,"proposition":"This is a type 2 fracture according to Garden's classification","justification":""},{"idx":2,"correct":false,"proposition":"This is a type 3 fracture according to Garden's classification","justification":""},{"idx":3,"correct":false,"proposition":"This is a type 4 fracture according to Garden's classification","justification":""},{"idx":4,"correct":true,"proposition":"Garden's classification does not apply for this type of fracture","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-5-qi-6","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"In view of the attached radiography of the pelvis, what is (are) the exact proposal(s)?","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"There is a deformation in coxa vara","justification":"The angle between the head and the diaphysis is well reduced."},{"idx":1,"correct":false,"proposition":"There are gaps in << the >> punch of the left iliac wing","justification":""},{"idx":2,"correct":false,"proposition":"This is a sub-capital divide","justification":""},{"idx":3,"correct":true,"proposition":"It is a fracture of the trochanterian massif","justification":""},{"idx":4,"correct":false,"proposition":"There is a loss of congruence of the right coxofemoral joint","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-5-qi-7","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"You explain to the patient that she has a fracture of the proximal femur that requires surgery. The patient is reluctant to have an intervention for fear of possible complications. Which proposal(s) is (are) accurate?","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"In the absence of intervention, fracture consolidation is possible","justification":""},{"idx":1,"correct":true,"proposition":"In the absence of intervention, there is a major risk of death related to complications of decubitus","justification":""},{"idx":2,"correct":true,"proposition":"The intervention is necessary to allow a rapid verticalization of the patient","justification":""},{"idx":3,"correct":true,"proposition":"The increase in the time before the intervention modifies the morbidity and mortality in the aftermath of the intervention","justification":""},{"idx":4,"correct":true,"proposition":"Stabilization surgery can effectively fight pain","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-5-qi-8","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"Regarding anesthesia, what can you say to this patient? (one or more correct answers)","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The choice between general or locoregional anaesthesia has no real influence on postoperative morbidity and mortality","justification":""},{"idx":1,"correct":true,"proposition":"It will be mandatory to place a venous catheter and that the patient remains fasting whether it is a general or locoregional anesthesia","justification":""},{"idx":2,"correct":false,"proposition":"There is no cardiac risk under regional anaesthesia","justification":""},{"idx":3,"correct":false,"proposition":"If the anaesthetist opts for regional anesthesia, the patient is not required to stay in the recovery room","justification":""},{"idx":4,"correct":true,"proposition":"Several analgesics are usually used multimodally to reduce morphine consumption postoperatively.","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-5-qi-9","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"Prior to her fall, the patient was travelling to the home without technical assistance. For the past few months, she had been using a cane for walks and when she went shopping, she used a rollator. What is the exact proposal(s)? ","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Parker's mobility score takes into account walking outside the home","justification":""},{"idx":1,"correct":false,"proposition":"Parker's mobility score is a quality of life score","justification":""},{"idx":2,"correct":true,"proposition":"Parker's mobility score ranges from O to 9","justification":""},{"idx":3,"correct":false,"proposition":"Parker mobility score takes into account the location of the fracture line","justification":""},{"idx":4,"correct":false,"proposition":"After a fracture of the upper extremity of the femur, recovery of the anterior Parker mobility score is the rule","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-5-qi-10","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"Which of the following leads to delay the surgical management of the patient? ","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The patient's refusal to be operated on","justification":""},{"idx":1,"correct":false,"proposition":"Antiplatelet therapy","justification":""},{"idx":2,"correct":false,"proposition":"A cutaneous opening next to the ulnar styloid","justification":""},{"idx":3,"correct":true,"proposition":"Hyperkalemia with ECG changes","justification":""},{"idx":4,"correct":false,"proposition":"A venous ulcer of the right leg","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-5-qi-11","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"In this patient, you opted for proximal femur osteosynthesis using intramedullary material. Following such an intervention, what is (are) the exact proposal(s)? ","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"There is a significant risk of dislocation","justification":""},{"idx":1,"correct":true,"proposition":"The risk of infection at the surgical site is low","justification":""},{"idx":2,"correct":true,"proposition":"The primary complication is the vicious callus.","justification":""},{"idx":3,"correct":false,"proposition":"If after one month, the fracture is not consolidated, it is a delay in consolidation","justification":""},{"idx":4,"correct":true,"proposition":"If after 8 months the fracture is not consolidated, it is pseudarthrosis","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-5-qi-12","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"Days after osteosynthesis, the patient slips on the wet floor on her way to the toilet and falls again. The patient complains of increased pain in the right hip. You take x-rays of the pelvis and right hip. What is the exact proposal(s)? ","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"There is a secondary displacement compared to intraoperative reduction plates","justification":""},{"idx":1,"correct":false,"proposition":"There is a dislocation of the right hip","justification":""},{"idx":2,"correct":false,"proposition":"There is a break in the hardware","justification":""},{"idx":3,"correct":false,"proposition":"There is a high risk of osteonecrosis of the femoral head","justification":""},{"idx":4,"correct":true,"proposition":"There is a decrease in the effectiveness of action of ilio-psoas","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-5-qi-13","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"During her fall, the patient also complains of spinal pain that you locate mainly at the thoracolumbar junction and which is accompanied by more diffuse pain. An MRI is performed. There is no transitional anomaly. In view of this review, what is the exact proposal(s)? ","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"There is a deformation of the vertebral body of T12","justification":""},{"idx":1,"correct":false,"proposition":"This is a sequence in T1","justification":""},{"idx":2,"correct":false,"proposition":"There is an antelisthesis of L4 on L5","justification":""},{"idx":3,"correct":true,"proposition":"The T12 fracture is recent","justification":""},{"idx":4,"correct":true,"proposition":"There are signs of disc degeneration between L 1 and L2","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-5-qi-14","context":"An 87-year-old woman is brought to the emergency room by firefighters following a fall at her home. The patient remained on the ground for an estimated 4 hours. She has functional impotence of the right lower limbwith pain in the fold of the right groin. She also has a painful deformity of the right wrist. On admission to the emergency room, she has a heart rate of 106 beats per minute, her blood pressure is 155\/75 mmHg, oxygen saturation is 91% and her capillary blood glucose is 1.44 g\/L (8 mmol\/L). His history includes an appendectomy at age 12, a non-insulin-dependent diabetes treated with metformin. The patient reports several falls in recent months. ","enonce":"The patient is reoperated on the right hip. In the aftermath of the intervention, she presents a state of agitation. Which element(s) of the clinical examination do you think is important in the etiological search for this state of agitation? ","item":"annales-2018-dp-5","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Performing a digital rectal exam","justification":""},{"idx":1,"correct":true,"proposition":"Abdominal palpation","justification":""},{"idx":2,"correct":true,"proposition":"Examination of cranial pairs","justification":""},{"idx":3,"correct":true,"proposition":"A measurement of capillary blood glucose","justification":""},{"idx":4,"correct":false,"proposition":"Performing the clock test","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-6-qi-1","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"Which of the following is(are) one or more criteria for severity of acute bronchiolitis in this child? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"His premature birth","justification":""},{"idx":1,"correct":false,"proposition":"Intercostal draw","justification":""},{"idx":2,"correct":true,"proposition":"Respiratory rate","justification":""},{"idx":3,"correct":false,"proposition":"High temperature","justification":"The criteria are very specific. Temperature is not one of them."},{"idx":4,"correct":true,"proposition":"His eating difficulties","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-6-qi-2","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"In this child, which is (are) the essential examination(s) ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Multiplex PCR for respiratory viruses","justification":""},{"idx":1,"correct":false,"proposition":"A rapid flu test","justification":""},{"idx":2,"correct":true,"proposition":"A chest X-ray","justification":""},{"idx":3,"correct":false,"proposition":"An arterial blood gas","justification":""},{"idx":4,"correct":false,"proposition":"A cardiac ultrasound","justification":"Careful! The new HAS 2019 recommendation taken up in the R2C colleges of pediatrics make this proposal obsolete."}],"type":"dp"}
+{"_id":"annales-2018-dp-6-qi-3","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"In front of this chest X-ray, what is(are) the exact answer(s)? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Presence of chest distension","justification":""},{"idx":1,"correct":false,"proposition":"Presence of pleural effusion","justification":""},{"idx":2,"correct":true,"proposition":"Presence of pneumomediastinum","justification":""},{"idx":3,"correct":true,"proposition":"Presence of mean lobar alveolar condensation","justification":"Medium lobe because erases the edges of the heart"},{"idx":4,"correct":false,"proposition":"The upper left arc is not visible","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-6-qi-4","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"The child is hospitalized for 4 rounds for the treatment of bronchiolitis complicated by pneumornediastin. It was fed the first two days by nasogastric tube. Infusion was not necessary. His respiratory signs are improving. While he was out, he presents vomiting followed twelve hours later by profuse diarrhea with a temperature of 37.3 ° C.  What is the possible cause(s) of this acute diarrhoea? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Adenovirus infection","justification":""},{"idx":1,"correct":true,"proposition":"Norovirus infection","justification":""},{"idx":2,"correct":true,"proposition":"C.","justification":""},{"idx":3,"correct":false,"proposition":"Enterovirus infection","justification":"He didn't get antibiotics. He is not feverish."},{"idx":3,"correct":false,"proposition":"RSV infection","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-6-qi-5","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"Regarding the episode of acute gastroenteritis of viral origin, which is(are) the exact statement(s)? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"It is an infection preventable by droplet precautions << >>","justification":""},{"idx":1,"correct":true,"proposition":"It is a certain nosocomial infection","justification":""},{"idx":2,"correct":false,"proposition":"The germ responsible for diarrhea is resistant to hydroalcoholic fluids (SHA)","justification":""},{"idx":3,"correct":false,"proposition":"It is necessary to make a declaration to the ARS (Regional Health Agency) of this infection","justification":""},{"idx":4,"correct":true,"proposition":"It is a manu-supported infection","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-6-qi-6","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"Given the severity of the picture, intravenous rehydration is decided. A blood sample is taken at the time of the infusion. The results of this assessment are as follows: natremia 125 mmol \/ L, serum potassium 3.7 mmol \/ l, blood glucose 7.4 mmol \/ L. What is (are) the possible diagnosis(s) in this child? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Cystic fibrosis","justification":""},{"idx":1,"correct":true,"proposition":"Oral rehydration with pure water given by parents","justification":""},{"idx":2,"correct":false,"proposition":"Intravenous rehydration with a solution not rich enough in sodium","justification":""},{"idx":3,"correct":false,"proposition":"Ulcerative-necrotizing enterocolitis","justification":""},{"idx":4,"correct":false,"proposition":"Hemolytic uremic syndrome (HUS)","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-6-qi-7","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"At the end of the infusion, the child makes clonic movements of the 4 limbs for 1 minute. It has no post-critical deficit. Which of the following diagnoses can be considered in this child? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"A complex febrile convulsion","justification":""},{"idx":1,"correct":true,"proposition":"An occasional seizure related to hyponatremia","justification":""},{"idx":2,"correct":false,"proposition":"West syndrome-type epilepsy","justification":""},{"idx":3,"correct":true,"proposition":"Cerebral venous thrombosis","justification":""},{"idx":4,"correct":false,"proposition":"Streptococcal B meningitis","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-6-qi-8","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"After a few days, his clinical condition has improved and you prepare the discharge, he weighs 6000g and by taking the health record you find that he has not been followed since his arrival in France and that no vaccination has been carried out. You worry about his psychomotor development. What are the expected acquisitions for his age? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Stacks two cubes","justification":"1 year"},{"idx":1,"correct":false,"proposition":"Repeats one syllable","justification":"6 months"},{"idx":2,"correct":false,"proposition":"Picks up objects with thumb-index clip","justification":"9 months"},{"idx":3,"correct":true,"proposition":"Play with his hands L","justification":""},{"idx":4,"correct":true,"proposition":"Laughs out loud","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-6-qi-9","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"Given the vaccine delay and its age, which of the following vaccines, is the one to be prioritized? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Influenza","justification":""},{"idx":1,"correct":true,"proposition":"Pneumococcus","justification":""},{"idx":2,"correct":true,"proposition":"Haemophilius","justification":""},{"idx":3,"correct":true,"proposition":"Meningococcal B","justification":""},{"idx":4,"correct":true,"proposition":"Measles","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-6-qi-10","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"Before the outing, which of the following dietary tips do you give to parents? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Use sterilized baby bottles","justification":""},{"idx":1,"correct":true,"proposition":"Bottles can be prepared with tap water","justification":""},{"idx":2,"correct":false,"proposition":"In case of family history of allergy, the introduction of peanut should be postponed","justification":""},{"idx":3,"correct":false,"proposition":"Cow's milk can replace infant milk from the age of 1 year","justification":""},{"idx":4,"correct":false,"proposition":"It will be necessary to give 5 fruits and vegetables per day 1 month after the beginning of diversification","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-6-qi-11","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"You see him again 2 months later for a new episode of respiratory discomfort. Parents tell you he's been cluttered and coughing since his last episode. Its weight is 6,100 g. What is (are) the possible diagnosis(s) given the history of this child? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Infant asthma","justification":""},{"idx":1,"correct":true,"proposition":"Cystic fibrosis","justification":""},{"idx":2,"correct":false,"proposition":"Coarctation of the aorta","justification":""},{"idx":3,"correct":true,"proposition":"Immunodeficiency","justification":""},{"idx":4,"correct":false,"proposition":"Eosinophilic esophagitis","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-6-qi-12","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"You suspect an immune deficiency. If confirmed, what vaccine(s) would be contraindicated in this child? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Injectable flu","justification":""},{"idx":1,"correct":true,"proposition":"Chickenpox","justification":""},{"idx":2,"correct":false,"proposition":"Pneumococcus","justification":""},{"idx":3,"correct":false,"proposition":"Meningococcal C","justification":""},{"idx":4,"correct":false,"proposition":"Hepatitis B","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-6-qi-13","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"No newborn screening was offered to this child. For children born in French maternity wards, newborn screening for cystic fibrosis: ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Requires signed parental consent for potential genetic research","justification":""},{"idx":1,"correct":false,"proposition":"Is proposed on the first day of life in case of delay in the emission of meconium","justification":""},{"idx":2,"correct":true,"proposition":"Is proposed on the third day of life","justification":""},{"idx":3,"correct":false,"proposition":"Consists of the analysis of the CFTR gene when the immunoreactive trypsin assay is below the threshold of positivity","justification":""},{"idx":4,"correct":true,"proposition":"Is sensitive but not very specific","justification":"There are many false positives but few false negatives: this is what we expect from a screening test (we do not want to miss a disease)."}],"type":"dp"}
+{"_id":"annales-2018-dp-6-qi-14","context":"A 5-month-old boy is brought to the pediatric emergency room at the end of September by his parents because they find that he is not breathing as usual. You have little information about pregnancy and birth, he was born at 36 weeks of amenorrhea, in a developing country. It weighed 2300 g. The parents arrived in France when he was one month old. It is fed from birth by mixed breastfeeding combining standard infant milk. For the past two days, parents have been reporting that his nose is running and he is coughing. They did not take the temperature but found it \"hot\". Since yesterday, he has been eating less well and has vomited his last bottle and has not wanted to drink anything since. No doctor was consulted. On clinical examination his respiratory rate is 65 per minute, his heart rate is 150 beats per minute, he has a moderate intercostal pull and discreet flapping of the wings of the nose, his body temperature is 39.3 ° C.  Its O2 saturation is 90%. ","enonce":"This child has a homozygous delta-F508 mutation. What support do you implement? ","item":"annales-2018-dp-6","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Daily chest physiotherapy sessions","justification":""},{"idx":1,"correct":false,"proposition":"Normal power supply","justification":""},{"idx":2,"correct":false,"proposition":"Interruption of breastfeeding","justification":""},{"idx":3,"correct":true,"proposition":"Oral supplementation of fat-soluble vitamins","justification":""},{"idx":4,"correct":true,"proposition":"Standard vaccination schedule","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-8-qi-1","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"The examination of the perianal region finds the following externalization at the pushing efforts.  Which of the following is correct? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The radial appearance of the folds is in favor of hemorrhoidal prolapse","justification":""},{"idx":1,"correct":false,"proposition":"The appearance of the lesion is in favor of cancer","justification":""},{"idx":2,"correct":false,"proposition":"The existence of haemorrhages on contact with or at the time of exemptions is in favour of cancerous degeneration.","justification":""},{"idx":3,"correct":true,"proposition":"The painless nature of the swelling is not in favor of hemorrhoidal thrombosis","justification":""},{"idx":4,"correct":false,"proposition":"This is a total externalized prolapse of the rectum","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-8-qi-2","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"You mention hemorrhoidal prolapse. Regarding your therapeutic care, what is (are) the exact proposal(s)?","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Regularization of transit is necessary to limit hemorrhoidal manifestations","justification":""},{"idx":1,"correct":false,"proposition":"This patient must be operated urgently, he risks thrombosis quickly","justification":""},{"idx":2,"correct":true,"proposition":"The regularization of transit and hygiene-dietary rules may be sufficient to relieve the patient","justification":""},{"idx":3,"correct":true,"proposition":"If he remains embarrassed after medical care, surgery may be considered","justification":""},{"idx":4,"correct":false,"proposition":"Hemorrhoids are a risk factor for cancer","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-8-qi-3","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"Regarding the care and follow-up of the patient, what is (are) the exact proposal(s)? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Once the hygiene-dietary rules are established, if the patient is relieved, there are no other examinations to perform","justification":""},{"idx":1,"correct":false,"proposition":"Surgery should be planned as soon as possible, there is no need to continue pre-operative explorations","justification":""},{"idx":2,"correct":true,"proposition":"The presence of rectal bleeding requires a colonoscopy","justification":""},{"idx":3,"correct":false,"proposition":"To authenticate bleeding, the patient may be offered a stool blood test.","justification":""},{"idx":4,"correct":false,"proposition":"In this context of symptomatic hemorrhoidal disease, colonoscopy can only be considered once the hemorrhoidal problem has been resolved.","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-8-qi-4","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"A colonoscopy under general anesthesia is performed. It highlights at the level of the sigmoid colon the following image that is not passable. Which of the following proposals concerning iconography is (are) accurate? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"It is an irregular and ulcerated lesion suggestive of a malignant tumor","justification":""},{"idx":1,"correct":false,"proposition":"It is an inflammatory colonic diverticulum","justification":""},{"idx":2,"correct":false,"proposition":"The mucosa around the lesion is inflammatory and suggestive of chronic inflammatory bowel disease","justification":""},{"idx":3,"correct":true,"proposition":"This lesion may explain the patient's increased constipation in recent months.","justification":""},{"idx":4,"correct":false,"proposition":"Endoscopic removal of the lesion is necessary to perform a total colonoscopy","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-8-qi-5","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"The biopsy confirms that it is a well-differentiated lieberkhunian adenocarcinoma. Which of the following proposals concerning the extension and pre-therapeutic assessment is (are) accurate? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The thoraco-abdomino-pelvic CT scan is the reference examination for the extension assessment of this colon cancer","justification":""},{"idx":1,"correct":false,"proposition":"The PET scan must be performed to detect locations not seen on the scanner","justification":""},{"idx":2,"correct":false,"proposition":"The patient cannot be operated on if the colonoscopy is not complete","justification":""},{"idx":3,"correct":false,"proposition":"The determination of CA 125 and CA 19.9 markers is indicated","justification":""},{"idx":4,"correct":true,"proposition":"It is necessary to schedule a new pre-operative anesthesia consultation","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-8-qi-6","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"There are no metastases. Which of the following proposals for patient care is correct? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"The patient's file must imperatively be presented in a multidisciplinary consultation meeting (RCP) before any treatment","justification":""},{"idx":1,"correct":true,"proposition":"Surgery is the gold standard treatment for non-metastatic colon cancer and the only curative option","justification":""},{"idx":2,"correct":false,"proposition":"Preoperative radiotherapy may be offered to improve the chances of local control of this advanced cancer","justification":""},{"idx":3,"correct":true,"proposition":"Chemotherapy may be indicated post-operative depending on the results of the histopathological examination of the operating room","justification":""},{"idx":4,"correct":false,"proposition":"Intraperitoneal intraperitoneal chemohyperthermia can be performed to prevent loco-regional recurrence","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-8-qi-7","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"You are planning a colectomy. Which of the proposals for the rules of cancer surgery is correct? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"A colectomy with tumour safety margins of at least 5 cm is required","justification":""},{"idx":1,"correct":true,"proposition":"A lymph node dissection requires at least 12 lymph nodes for proper assessment of lymph node status","justification":""},{"idx":2,"correct":true,"proposition":"A colectomy with restoration of digestive continuity and without stoma is the rule in this situation apart from the emergency or an intraoperative abnormality","justification":""},{"idx":3,"correct":false,"proposition":"A stoma must be performed because the tumor has evolved and chemotherapy must be started quickly","justification":""},{"idx":4,"correct":true,"proposition":"In case of discovery of peritoneal carcinomatosis during the intervention, it is allowed to postpone the colectomy and to discuss the patient's file again in multidisciplinary consultation meeting","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-8-qi-8","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"The patient is operated in good conditions, with a restoration of continuity at the same time operative. The report of the histopathological examination concludes that circumlateral adenocarcinoma invades the sub-serosa. There is an invaded lymph node out of the 13 examined. There are vascular embols and perinervous sheaths. There is instability of micro-satellites. Which of the proposals concerning the stage of the disease and its prognosis is (are) accurate? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"It is a pT3N1 tumour","justification":""},{"idx":1,"correct":true,"proposition":"It is stage III colon cancer","justification":""},{"idx":2,"correct":false,"proposition":"The prognosis for overall survival at 5 years is 95%","justification":""},{"idx":3,"correct":true,"proposition":"The presence of vascular emboli is a factor of poor prognosis","justification":""},{"idx":4,"correct":false,"proposition":"Peri-nervous sheathing has no impact on prognosis","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-8-qi-9","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"The postoperative period is marked by the appearance of a fever at 38.5 ° C on the 5th day.   Which of the following is correct?","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"It is necessary to evoke a complication type of anastomotic fistula","justification":""},{"idx":1,"correct":true,"proposition":"A complete blood count is indicated","justification":""},{"idx":2,"correct":true,"proposition":"A cytobacteriological examination of urine is indicated in this patient who has undergone urinary catheterization for his procedure","justification":""},{"idx":3,"correct":false,"proposition":"A determination of D-dimer must be carried out","justification":""},{"idx":4,"correct":true,"proposition":"Palpation of the abdominal scar is essential","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-8-qi-10","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"A wall abscess was removed. The sequels are ultimately simple. The patient leaves the ward on Day 7. Regarding the continuation of the care during the first year, which proposal(s) is(are) accurate? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"A colonoscopy should be performed within 6 months as the initial examination was not complete","justification":""},{"idx":1,"correct":true,"proposition":"Given lymph node invasion, adjuvant chemotherapy is indicated","justification":""},{"idx":2,"correct":false,"proposition":"Given the importance of parietal (subserosa) involvement, postoperative radiotherapy should be offered","justification":""},{"idx":3,"correct":true,"proposition":"As part of the patient's management, his colon cancer enters the list of conditions eligible for 100% coverage","justification":""},{"idx":4,"correct":false,"proposition":"Clinical and ultrasound monitoring should be semi-annually","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-8-qi-11","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"What is the element of anamnesis that makes you propose to the patient an onco-genetic consultation? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Age","justification":""},{"idx":1,"correct":false,"proposition":"The stenosing character of the tumor","justification":""},{"idx":2,"correct":false,"proposition":"Localization in the sigmoid colon","justification":""},{"idx":3,"correct":false,"proposition":"The presence of vascular emboli on histological examination","justification":""},{"idx":4,"correct":true,"proposition":"The instability of micro-satellites","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-8-qi-12","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"Which of the following cancers is (are) on the narrow spectrum of Lynch syndrome? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Cancer of the urinary excretory tract","justification":"Two mnemonics: GOBES and VICE (see the mnemo means tab)"},{"idx":1,"correct":false,"proposition":"Breast cancer","justification":""},{"idx":2,"correct":true,"proposition":"Endometrial cancer","justification":""},{"idx":3,"correct":false,"proposition":"Thyroid cancer","justification":""},{"idx":4,"correct":true,"proposition":"Small intestine cancer","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-8-qi-13","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"Finally the patient receives adjuvant chemotherapy that he tolerates well. He wishes to resume his professional activity within a month of the end of his chemotherapy. What can you offer him as a doctor? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Encourage them to file an application for recognition as a disabled worker (RQTH)","justification":""},{"idx":1,"correct":false,"proposition":"Write him a certificate of aptitude for the resumption of his professional activity","justification":""},{"idx":2,"correct":true,"proposition":"Send it now to the occupational physician of his company for a pre-resumption visit","justification":""},{"idx":3,"correct":true,"proposition":"Prescribe part-time for therapeutic reasons","justification":""},{"idx":4,"correct":false,"proposition":"Submit an application for an adult disabled allowance (AAH)","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-8-qi-14","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"A year later, the surveillance scanner shows the following image. Regarding this iconography, which is (are) the exact proposal(s)? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"It is a CT scan injected at arterial time","justification":""},{"idx":1,"correct":true,"proposition":"We individualize on this picture the spleen","justification":""},{"idx":2,"correct":true,"proposition":"A hypodense image compatible with liver metastasis is found","justification":""},{"idx":3,"correct":true,"proposition":"This lesion is located in the left liver","justification":""},{"idx":4,"correct":true,"proposition":"The stomach is visible in this picture","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-8-qi-15","context":"A 50-year-old man consults you, referred by his doctor for discomfort at the time of bowel movements. This is a patient with no personal or family history. He is not undergoing treatment. He is the father of 3 healthy children, the eldest is 21 years old. He works as an executive in a company, in charge of customer relations. The symptoms started a year ago. The patient describes, at the time of the exemptions, the non-painful externalization of a \"ball\" that reintegrates spontaneously. Its intestinal transit has always been capricious, with episodes of constipation that have nevertheless worsened in recent months. He also rarely has episodes of bleeding after bowel movements. Your clinical examination is normal at the general and abdominal level. ","enonce":"This is actually a single liver metastasis of his colorectal cancer. Which of the following proposals for the management of this patient is correct? ","item":"annales-2018-dp-8","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"His file must be represented in a multidisciplinary consultation meeting (RCP)","justification":""},{"idx":1,"correct":true,"proposition":"Excision surgery can treat this patient curatively","justification":""},{"idx":2,"correct":true,"proposition":"A preoperative PET scan may be indicated to ensure the absence of further distant metastases","justification":""},{"idx":3,"correct":true,"proposition":" Chemotherapy may be offered to assess the tumor's response to treatment","justification":""},{"idx":4,"correct":false,"proposition":"In this patient already operated on the colon, an intervention on the liver is no longer possible","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-9-qi-1","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"Regarding the facial nerve, which proposals are accurate? (one or more possible answers) ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":" It has a vegetative action","justification":""},{"idx":1,"correct":false,"proposition":"Its sensory ganglion is the trigeminal ganglion","justification":""},{"idx":1,"correct":false,"proposition":"His elbow separates his first portion from his second","justification":"It separates the second portion from the third"},{"idx":1,"correct":true,"proposition":"It innervates the stirrup muscle","justification":""},{"idx":1,"correct":true,"proposition":"It includes an intrapetrous position","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-9-qi-2","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"During peripheral facial paralysis: ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The motor deficit is homogeneous affecting both the upper and lower territory","justification":""},{"idx":1,"correct":false,"proposition":"There is an automatic-voluntary dissociation","justification":""},{"idx":2,"correct":true,"proposition":"We can observe a sign of Charles-Bell","justification":""},{"idx":3,"correct":true,"proposition":"We can observe a sign of the eyelashes of Souques","justification":""},{"idx":4,"correct":false,"proposition":"Facial features are deflected to the paralyzed side","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-9-qi-3","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"What are the additional examinations that you will carry out initially? ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Bilateral otoscopy","justification":""},{"idx":1,"correct":true,"proposition":"Examination of other cranial pairs","justification":""},{"idx":2,"correct":true,"proposition":"Tonal audiometry","justification":""},{"idx":3,"correct":true,"proposition":"Search for stapedial reflexes","justification":""},{"idx":4,"correct":true,"proposition":"Speech audiometry","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-9-qi-4","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"What diagnosis do you evoke in front of this aspect? ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Seromucosal otitis","justification":""},{"idx":1,"correct":false,"proposition":"Fibroadhesive otitis","justification":""},{"idx":2,"correct":false,"proposition":"Earwax cap","justification":""},{"idx":3,"correct":true,"proposition":"Cholesteatoma","justification":""},{"idx":4,"correct":false,"proposition":"Retraction bag","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-9-qi-5","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"You diagnose a cholesteatoma. You perform a tonal audiometry of which here is the result. These curves are characteristic of: ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Right-hand transmission hearing loss","justification":""},{"idx":1,"correct":false,"proposition":"Left sensorineural hearing loss","justification":""},{"idx":2,"correct":false,"proposition":"Left mixed deafness","justification":""},{"idx":3,"correct":true,"proposition":"Left transmission hearing loss","justification":""},{"idx":4,"correct":false,"proposition":"Righteous sensorineural hearing loss","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-9-qi-6","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"You diagnose left-handed conductive hearing loss. You perform an acoumetry. What is the exact proposal(s): ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"In the Weber test, the sound is lateralized on the left side.","justification":""},{"idx":1,"correct":false,"proposition":"Weber's test will be said to be positive","justification":"Weber is neither positive nor negative: he is either lateralized or non-lateralized."},{"idx":2,"correct":true,"proposition":"Rinne's test will be said to be negative","justification":""},{"idx":3,"correct":true,"proposition":"In the Rinne test, bone conduction will be better than air conduction","justification":""},{"idx":4,"correct":false,"proposition":"Stageian reflexes will be present","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-9-qi-7","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"Regarding the innervation of the face and neck:","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"A section of the right hypoglossal nerve will cause during protraction a deviation of the tongue to the left","justification":""},{"idx":1,"correct":false,"proposition":"The levator muscle of the upper eyelid is innervated by the trochlear nerve","justification":""},{"idx":2,"correct":false,"proposition":"A section of the right vagus nerve at the mediastinal level will lead to paralysis of the right hemilarynx","justification":""},{"idx":3,"correct":true,"proposition":"A section of the left cervical sympathetic trunk will lead to Claude Bernard-Homer syndrome","justification":""},{"idx":4,"correct":true,"proposition":"The lateral rectus muscle is innervated by the abducens nerve","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-9-qi-8","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"The clinical examination of this patient shows that when the eyes are closed, his left eye does not close completely and that the deviation of the mouth is well obfecled at rest. You propose as early management:","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Facial electrotherapy","justification":""},{"idx":1,"correct":false,"proposition":"Oral amoxicillin","justification":""},{"idx":2,"correct":true,"proposition":"Eye care","justification":""},{"idx":3,"correct":false,"proposition":"Antiviral treatment with valaciclovir","justification":""},{"idx":4,"correct":true,"proposition":"Facial physiotherapy","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-9-qi-9","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"You carry out as an additional examination (an expected answer): ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Schüller incidence radiography","justification":""},{"idx":1,"correct":true,"proposition":"Scanning of the two rocks without injection of contrast medium","justification":""},{"idx":2,"correct":false,"proposition":"Bone scintigraphy","justification":""},{"idx":3,"correct":false,"proposition":"Early auditory evoked potentials","justification":""},{"idx":4,"correct":false,"proposition":"Microbiological","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-9-qi-10","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"You perform a scan of both rocks without injection. On this scanner section of the left rock: ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Arrow 1 designates the vestibule","justification":""},{"idx":1,"correct":true,"proposition":"Arrow 1 points to the cochlea","justification":""},{"idx":2,"correct":true,"proposition":"2 refers to the internal auditory canal","justification":""},{"idx":3,"correct":false,"proposition":"2 refers to the eardrum box","justification":""},{"idx":4,"correct":false,"proposition":"3 refers to the internal carotid artery","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-9-qi-11","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"You propose as support for this chollessteatoma (an expected response): ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Treatment with amoxicillin-clavulanic acid for fifteen days","justification":""},{"idx":1,"correct":false,"proposition":"An instillation of ofloxacin in ear drops, one dose twice daily for one month","justification":""},{"idx":2,"correct":false,"proposition":"A 6-month consultation for a new otoscopy","justification":""},{"idx":3,"correct":true,"proposition":"Surgical treatment","justification":""},{"idx":4,"correct":false,"proposition":"Iterative aspirations under a microscope","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-9-qi-12","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"You operated on this patient by performing a first time of tympanoplasty. You then discuss with him the continuation of his care: ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The patient is at risk of residual cholesteatoma","justification":""},{"idx":1,"correct":true,"proposition":"Monitoring will include regular audiogram","justification":""},{"idx":2,"correct":true,"proposition":"The patient is at risk of recurrent cholesteatoma","justification":""},{"idx":3,"correct":true,"proposition":"Monitoring will include regular imaging","justification":""},{"idx":4,"correct":true,"proposition":"Monitoring will include regular otoscopy","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-9-qi-13","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"The patient does not return to the various follow-up consultations you have scheduled. Three years after the surgery, he consults you again urgently for a large vertigo of sudden beginning, appeared since the day before, accompanied by nausea and vomiting. You are diagnosed with left harmonious vestibular syndrome. You will find at the clinical examination: ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"A right horizontal-rotational nystagmus","justification":""},{"idx":1,"correct":true,"proposition":"During nystagmus, a slow deviation of the eyes to the left","justification":""},{"idx":2,"correct":false,"proposition":"A blind walk deviated to the right","justification":""},{"idx":3,"correct":true,"proposition":"At the maneuver of the outstretched arms, a deviation of the index fingers to the left","justification":""},{"idx":4,"correct":false,"proposition":"Nystagmus persists with eye fixation","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-9-qi-14","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"On otoscopy, you visualize a recurrence of cholesteatoma. Clinical examination shows no involvement of the other cranial pairs. The audiogram shows bone conduction similar to that existing post-operatively. The most likely diagnosis is ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Left vestibular neuritis","justification":""},{"idx":1,"correct":false,"proposition":"Right Wallenberg syndrome","justification":""},{"idx":2,"correct":false,"proposition":"Thrombosis of the left internal auditory artery","justification":""},{"idx":3,"correct":true,"proposition":"Lysis of the left lateral semicircular canal","justification":""},{"idx":4,"correct":false,"proposition":"Spontaneous fracture of the left rock","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-9-qi-15","context":"A 45-year-old man with no medical-surgical history consults you urgently for a left facial paralysis that appeared suddenly a few hours ago. ","enonce":"You suspect lysis of the left lateral semicircular canal. You prescribe as additional examinations ","item":"annales-2018-dp-9","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Standard X-ray incidence << rock in orbit >>","justification":""},{"idx":1,"correct":true,"proposition":"Videonystagmography","justification":""},{"idx":2,"correct":true,"proposition":"Left rock scanner without injection","justification":""},{"idx":3,"correct":false,"proposition":"Microbiological","justification":""},{"idx":4,"correct":false,"proposition":"Electromyogram of the face","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-10-qi-1","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"You want to specify the abnormalities found on the blood count. What additional examinations are you requesting? (one or more possible answers) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Determination of vitamin B9","justification":"Anemia is not microcytic"},{"idx":1,"correct":false,"proposition":"TSH test","justification":"Anemia is not normocytic"},{"idx":2,"correct":false,"proposition":"Determination of vitamin B12","justification":"Anemia is not microcytic"},{"idx":3,"correct":true,"proposition":"Determination of ferritinemia","justification":""},{"idx":4,"correct":true,"proposition":"CRP testing","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-10-qi-2","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"What can be the reasons for the hyperplatektosis? (one or more possible answers) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Vitamin deficiency","justification":""},{"idx":1,"correct":true,"proposition":"Iron deficiency","justification":""},{"idx":2,"correct":true,"proposition":"Inflammatory syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Beginning myeloproliferative syndrome","justification":""},{"idx":4,"correct":false,"proposition":"Hemolysis","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-10-qi-3","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"You examine the patient. He has left axillary lymphadenopathy. It has no hepatosplenomêgalie. Blood pressure is at 130\/70. The temperature is 37.1°C at the time of the examination. It has very pale skin and you notice a slight thoracic collateral circulalion. You suspect superior cava syndrome. What signs will you look for in favor of this diagnosis? (one or more possible answers) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Shortness of breath when lying down","justification":""},{"idx":1,"correct":false,"proposition":"Stellar angiomas","justification":"This is a sign of hepatocellular insufficiency."},{"idx":2,"correct":true,"proposition":"Jugular turgor","justification":""},{"idx":3,"correct":true,"proposition":"An edema filling the supraclavicular hollows","justification":""},{"idx":4,"correct":false,"proposition":"Edema of the lower limbs","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-10-qi-4","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"He actually does not tolerate the lying position well and sleeps with 2 pillows. Suspecting lymphoma pathology, you refer the patient for hospitalization in hematology. A PET scan is performed quickly. About this review, which propositions are true? (one or more possible answers) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"The marker used is iron-based","justification":"It is glucose-based"},{"idx":1,"correct":true,"proposition":"This is an examination indicated in the initial assessment of aggressive lymphomas","justification":""},{"idx":2,"correct":true,"proposition":"Tumor metabolism is evaluated by the SUV (Standard Uptake Value)","justification":""},{"idx":3,"correct":true,"proposition":"The patient must be fasting","justification":""},{"idx":4,"correct":false,"proposition":"The patient should be infused with glucose serum","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-10-qi-5","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"What is your interpretation? (one or more possible answers) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"There is supra- and subdiaphragmatic lymph node involvement","justification":""},{"idx":1,"correct":false,"proposition":"There is myocardial involvement","justification":""},{"idx":2,"correct":true,"proposition":"It is compatible with an Ann Arbor Stage II","justification":""},{"idx":3,"correct":false,"proposition":"There are many artifacts that hinder interpretation","justification":""},{"idx":4,"correct":false,"proposition":"There is probable damage to the urinary tract","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-10-qi-6","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"The PET scan shows hypermetabolic axillary and mediastinal lymphadenopathy (SUV> 10). What exploration modalities do you choose in this context? (one or more possible answers)","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":" Biopsy of axillary lymphadenopathy","justification":""},{"idx":1,"correct":false,"proposition":"Cytopuncture of axillary lymphadenopathy","justification":""},{"idx":2,"correct":false,"proposition":"Axillary dissection with extemporaneous examination","justification":""},{"idx":3,"correct":false,"proposition":"Immediate fixing of the levy","justification":""},{"idx":4,"correct":false,"proposition":"Mediastinoscopy and mediastinal mass sampling","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-10-qi-7","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"You perform a biopsy of an axillary lymph node. The histological report comes back to you: large cells with destroyed architecture, tumor cells expressing CD20. What is the most likely histological diagnosis? (only one answer expected) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Hodgkin's disease","justification":""},{"idx":1,"correct":true,"proposition":"Diffuse large cell non-Hodgkin B-cell lymphoma","justification":""},{"idx":2,"correct":false,"proposition":"T-cell lymphoma","justification":""},{"idx":3,"correct":false,"proposition":"Follicular lymphoma","justification":""},{"idx":4,"correct":false,"proposition":"Sarcoidosis","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-10-qi-8","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"The diagnosis of diffuse large cell B-cell lymphoma is retained. You perform an osteomedullary biopsy and lumbar puncture which are normal. You want to calculate the usual prognostic score (IPI for international prognostic index) in this patient. What do you need? (one or more possible answers) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Sex","justification":""},{"idx":1,"correct":true,"proposition":"Age","justification":""},{"idx":2,"correct":true,"proposition":"Ann Arbor Clinical Stage","justification":""},{"idx":3,"correct":false,"proposition":"Beta2 microglobulin","justification":""},{"idx":4,"correct":true,"proposition":"LDH","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-10-qi-9","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"What do you offer the patient before starting treatment? (one or more possible answers) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Hepatitis B and C serologies","justification":""},{"idx":1,"correct":false,"proposition":"Brain MRI","justification":""},{"idx":2,"correct":true,"proposition":"Cardiac ultrasound with ejection fraction measurement","justification":""},{"idx":3,"correct":false,"proposition":"HLA typing","justification":""},{"idx":4,"correct":true,"proposition":"Sperm cryopreservation at CECOS","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-10-qi-10","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"You are starting immunochemotherapy such as rituximab, doxorubicin, vindesine, cyclophosphamide, bleomycin and prednisone. What are the classic side effects of doxorubicin (anthracycline): (one or more possible responses)","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Cardiomyopathy","justification":""},{"idx":1,"correct":true,"proposition":"Extensive skin necrosis in case of extravasation","justification":""},{"idx":2,"correct":false,"proposition":"Pulmonary fibrosis","justification":""},{"idx":3,"correct":false,"proposition":"Dysthyroidism","justification":""},{"idx":4,"correct":true,"proposition":"Alopecia","justification":"Non-alopecic chemotherapies to know for NEC are platinum salts, 5-FU and methotrexate."}],"type":"dp"}
+{"_id":"annales-2018-dp-10-qi-11","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"Rituximab: (one or more possible answers) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Is a mouse monoclonal antibody","justification":"xi = chimerical"},{"idx":1,"correct":false,"proposition":"Is an antibody recognizing CD34 surface antigen","justification":""},{"idx":2,"correct":true,"proposition":"May cause viral hepatitis reactivations","justification":""},{"idx":3,"correct":true,"proposition":"May cause cytokine release syndrome on first infusion","justification":""},{"idx":4,"correct":true,"proposition":"Causes B-cell","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-10-qi-12","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"At 10 days of chemotherapy, the patient who is at home, calls you because he is feverish with several temperature peaks at 39 ° C and chills. The blood count carried out the day before shows Hemoglobin 91 g \/ dL, Leukocytes 1.8 G \/ L, neutrophils 0.4 G \/ L, Lymphocytes 1.2 GIL, Monocytes 0.2 G \/ L, Platelets 50 G \/ L. What are the proposals that apply to the blood count? (one or more correct answers) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Pancytopenia","justification":""},{"idx":1,"correct":true,"proposition":"Neutropenia","justification":""},{"idx":2,"correct":true,"proposition":"Lymphopenia","justification":""},{"idx":3,"correct":false,"proposition":"Monocytosis","justification":""},{"idx":4,"correct":true,"proposition":"Thrombocytopenia","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-10-qi-13","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"What attitude do you adopt? ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"You prescribe antibiotic therapy with amoxicillin","justification":""},{"idx":1,"correct":false,"proposition":"You resume corticosteroid therapy","justification":""},{"idx":2,"correct":false,"proposition":"You make him do a chest x-ray in town in emergency","justification":""},{"idx":3,"correct":true,"proposition":"You hospitalize him urgently","justification":""},{"idx":4,"correct":false,"proposition":"You ask him to contact you again after 12 hours of antibiotic treatment","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-10-qi-14","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"When he arrives in the hematology department, what examinations must be carried out urgently? (one or more possible answers) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Blood","justification":""},{"idx":0,"correct":true,"proposition":"ECBU","justification":""},{"idx":0,"correct":false,"proposition":"Myelogram","justification":""},{"idx":0,"correct":false,"proposition":"Microbiological","justification":""},{"idx":0,"correct":false,"proposition":"LDH","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-10-qi-15","context":"A 37-year-old man comes to see you because he has been tired for several weeks. He does not take any medication. He has lost 6 kg in the last six months and weighs 73 kg for 1.80 m.Il carries out his daily activities with a little difficulty because he sleeps badly at night especially because of sweats forcing him to change. He has noticed in recent weeks a \"lump\" under the arm. The blood count finds: Hemoglobin 102 g \/ L, VGM 79 fL, CCMH 28 g \/ dl, Hematocrit 36%, Platelets 520 G \/ L, Leukocytes 8 G \/ L, PNN 5 G \/ L Lymphocytes 2.5 G \/ L, Monocytes 0.5 G \/ L ","enonce":"After taking blood cultures and an ECBU, what therapeutic attitude do you adopt? (one or more possible answers) ","item":"annales-2018-dp-10","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Protective Custody","justification":""},{"idx":1,"correct":false,"proposition":"Antibiotic therapy started after blood culture results","justification":""},{"idx":2,"correct":false,"proposition":"Intravenous antifungal","justification":""},{"idx":3,"correct":false,"proposition":"Corticosteroid therapy","justification":""},{"idx":4,"correct":false,"proposition":"Transfusion of red blood cells","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-11-qi-1","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"What late complication(s) may result from contusive eye trauma? Decreased mydriasis of the photomotor reflex","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Retinal detachment","justification":""},{"idx":1,"correct":false,"proposition":"Retinal edema","justification":""},{"idx":2,"correct":true,"proposition":"Ocular hypertonia","justification":""},{"idx":3,"correct":true,"proposition":"A cataract","justification":""},{"idx":4,"correct":true,"proposition":"Mydriasis with decreased photomotor reflex","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-11-qi-2","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"Which symptom(s) would be suggestive of a cataract?","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Photophobia","justification":""},{"idx":1,"correct":true,"proposition":"A monocular diplopia","justification":""},{"idx":2,"correct":false,"proposition":"Metamorphopsies","justification":""},{"idx":3,"correct":false,"proposition":"Phosphenes","justification":""},{"idx":4,"correct":false,"proposition":"Visual field amputation","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-11-qi-3","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"Which symptom(s) would be suggestive of retinal detachment? ","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Photophobia","justification":""},{"idx":1,"correct":false,"proposition":"A monocular diplopia","justification":""},{"idx":2,"correct":false,"proposition":"Lagophthalmos","justification":""},{"idx":3,"correct":true,"proposition":"Phosphenes","justification":""},{"idx":4,"correct":true,"proposition":"Visual field amputation","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-11-qi-4","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"Your clinical examination regains a visual acuity measured at 10\/10 P2 with a correction in glasses of -1 (-0.50 to 85 °) in the right eye, and << see the hand move >> with -3 (-0.75 to 75 °) on the left eye. What refractive disorder(s) is present in this patient ","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Low myopia"},{"idx":1,"correct":false,"proposition":"Strong myopia"},{"idx":2,"correct":false,"proposition":"Hyperopia"},{"idx":3,"correct":false,"proposition":"Unepresbyopia"},{"idx":4,"correct":true,"proposition":"Astigmatism"}],"type":"dp"}
+{"_id":"annales-2018-dp-11-qi-5","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"Intraocular pressure is measured at 18 mm Hg in the right eye and 20 mm Hg in the left eye. The examination of the anterior segment of the right eye is without departure. Examination of the anterior segment of the left eye finds a deep anterior chamber and a total white cataract. The examination of the eye food is unremarkable on the right side and not visible on the left side. What other abnormality(s) of traumatic origin could you find in the anterior segment of the left eye? ","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"A miosis","justification":""},{"idx":1,"correct":true,"proposition":"Subluxation of the lens","justification":""},{"idx":2,"correct":true,"proposition":"Iridodialysis","justification":""},{"idx":3,"correct":true,"proposition":"A rupture of the iris sphincter","justification":""},{"idx":4,"correct":false,"proposition":"Central corneal opacification","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-11-qi-6","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"What additional examination(s) are you requesting to clarify the condition of the eye structures of the left eye? ","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"An examination of the visual field","justification":""},{"idx":1,"correct":false,"proposition":"Optical coherence tomography (macular OCT).","justification":""},{"idx":2,"correct":true,"proposition":"An ocular ultrasound in mode B","justification":""},{"idx":3,"correct":false,"proposition":"Keratometry","justification":""},{"idx":4,"correct":false,"proposition":"An orbital scanner","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-11-qi-7","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"What examination(s) are needed before cataract surgery? ","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Pachymetry","justification":""},{"idx":1,"correct":true,"proposition":"Keratometry","justification":""},{"idx":2,"correct":false,"proposition":"A corneal topography","justification":""},{"idx":3,"correct":true,"proposition":"A measurement of the axial length of the eye","justification":""},{"idx":4,"correct":false,"proposition":"A kinetic Goldmann visual field","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-11-qi-8","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"The ultrasound is without particularity to the left eye. You offer the patient cataract surgery on his left eye. What explanation(s) do you give to the patient? ","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Surgery is performed during a traditional 2-day hospitalization","justification":"Outpatient, without hospitalization"},{"idx":1,"correct":true,"proposition":"Anesthesia is most often local or locoregional","justification":""},{"idx":2,"correct":true,"proposition":"Visual recovery cannot be estimated because the fundus is not visible","justification":"It is necessary to see the state of the retina (which echo B does not allow) to have a prognosis of visual recovery."},{"idx":3,"correct":true,"proposition":"Complications are rare but can lead to loss of function of the eye","justification":""},{"idx":4,"correct":false,"proposition":"The absence of lens will be corrected by a corrective lens","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-11-qi-9","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"The cataract operation does not go as planned. At the time of phacoemulsification, there is a large posterior capsular rupture.  What is (are) the possibility(s) of correction of aphakia in this case?","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Placement of a multifocal implant in the capsular bag","justification":""},{"idx":1,"correct":true,"proposition":"Placement of an anterior chamber implant ","justification":""},{"idx":2,"correct":false,"proposition":"Placement of a monofocal implant in the capsular bag","justification":""},{"idx":3,"correct":true,"proposition":"A correction by a contact lens","justification":""},{"idx":4,"correct":true,"proposition":"A correction by glasses","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-11-qi-10","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"The operation finally tennine well and an anterior chamber implant is placed. Three weeks after the operation the patient consults urgently for a decrease in visual acuity of the left eye associated with a white and painless eye with a calm anterior segment. What diagnosis(s) do you mention?","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Retinal detachment"},{"idx":1,"correct":false,"proposition":"Acute anterior uveitis","justification":""},{"idx":2,"correct":false,"proposition":"Acute post-operative endophthalmitis","justification":""},{"idx":3,"correct":true,"proposition":"Macular edema"},{"idx":4,"correct":false,"proposition":"A clouding of the posterior capsule","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-11-qi-11","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"The visual acuity of the left eye is measured at 5\/10 Parinaud 5 with a correction. Intraocular pressure is measured at 20 mm Hg and examination of the anterior segment is unremarkable. Examination of the fundus finds a loss of foveolar reflection. Which additional exam(s) are you requesting:","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"An examination of the visual field","justification":""},{"idx":1,"correct":false,"proposition":"An ultrasound in mode B","justification":""},{"idx":2,"correct":true,"proposition":"Macular optical coherence tomography (OCT)","justification":"We want to see the macula to objectify an edema of Irvin Gass."},{"idx":3,"correct":false,"proposition":"Visual evoked potentials","justification":""},{"idx":4,"correct":false,"proposition":"An electroretinogram","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-11-qi-12","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"A macular optical coherence tomography (OCT) scan is performed. There is a post-operative macular edema of cataract surgery, which is (are) the exact proposal(s)? ","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"It is of infectious origin","justification":""},{"idx":1,"correct":false,"proposition":"It is accompanied by hemorrhages and cottony nodules","justification":""},{"idx":2,"correct":true,"proposition":"It is of inflammatory origin","justification":""},{"idx":3,"correct":true,"proposition":"It occurs in post-operative weeks or months","justification":""},{"idx":4,"correct":true,"proposition":"Local or loco-regional anti-inflammatory treatment is often effective","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-11-qi-13","context":"A 38-year-old patient presents for consultation because he feels a very significant decrease in visual acuity on his left eye appeared gradually and painlessly in a few months. It has no particular general antecedent. At the ophthalmological level, he had already consulted 10 years ago after receiving a tennis ball in the left eye. He also remembers that he was recommended to be checked regularly following this episode. ","enonce":"The patient consults again 3 years later because his visual acuity has deteriorated. It is quantifiable with the left eye at 1\/1O Parinaud 5 with the best optical correction. In this context of post-traumatic cataract and anterior chamber implant, what diagnosis(s) can (s) be evoked to explain this decrease in visual acuity? ","item":"annales-2018-dp-11","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Posterior vitreous detachment","justification":""},{"idx":1,"correct":true,"proposition":"Corneal edema","justification":""},{"idx":2,"correct":false,"proposition":"Peritasicular drusens","justification":""},{"idx":3,"correct":true,"proposition":"Retinal detachment","justification":""},{"idx":4,"correct":false,"proposition":"Bacterial endophthalmitis","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-12-qi-1","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"After listening to the patient, you seek clarification of certain symptoms.  It seems important to you to look for the presence (or absence) of: ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Epistaxis","justification":""},{"idx":1,"correct":true,"proposition":"Arthralgia","justification":""},{"idx":2,"correct":true,"proposition":"Red eye","justification":""},{"idx":3,"correct":true,"proposition":"Hemoptysis","justification":""},{"idx":4,"correct":true,"proposition":"Dyspnoea","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-12-qi-2","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"The patient confirms the presence of arthralgia. He had no epistaxis or red eye episodes. On the other hand, it is dyspneic and the Sp02 taken during the consultation is 94% in ambient air. Blood pressure is measured at 110\/65 mmHg. The pulse is at 85\/minute. You propose to the patient to carry out biological analyzes. You ask the nurse to sample: ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"A C-reactive protein assay","justification":""},{"idx":1,"correct":true,"proposition":"Blood cultures","justification":""},{"idx":2,"correct":true,"proposition":"A search for antinuclear antibodies","justification":""},{"idx":3,"correct":false,"proposition":"An anticardiolipin antibody assay","justification":""},{"idx":4,"correct":true,"proposition":"A plasma creatinine assay","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-12-qi-3","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"With the clinical context, these results point you towards ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Sjögren's syndrome","justification":""},{"idx":1,"correct":false,"proposition":"Systemic lupus","justification":""},{"idx":2,"correct":false,"proposition":"An antiphospholipid antibody syndrome","justification":""},{"idx":3,"correct":true,"proposition":"Vasculitis","justification":""},{"idx":4,"correct":false,"proposition":"Sarcoidosis","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-12-qi-4","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"You turn to vasculitis and decide to hospitalize the patient in the internal medicine department. The rest of the results arrive quickly especially the C-reactive protein which is at 451 mg \/ L. The available results are shown here. Chronic inflammation alone allows you to explain: ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Microcytosis","justification":""},{"idx":1,"correct":true,"proposition":"Thrombocytosis","justification":""},{"idx":2,"correct":false,"proposition":"Eosinophilia","justification":""},{"idx":3,"correct":true,"proposition":"The increase in alpha-2 globulins","justification":""},{"idx":4,"correct":false,"proposition":"Lymphopenia","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-12-qi-5","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"With regard to ANCAs, it is true that: ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"They are looking for each other in direct immunofluorescence","justification":"Indirect (direct FI refers to solid biopsies)."},{"idx":1,"correct":true,"proposition":"They are mainly directed against myeloperoxidase or proteinase 3","justification":""},{"idx":2,"correct":false,"proposition":"They are directed against the cytoplasm of eosinophilic polynuclear","justification":"PNN"},{"idx":3,"correct":false,"proposition":"They are directed against the cytoplasm of Hep-2 cells","justification":""},{"idx":4,"correct":false,"proposition":"Their positivity in this patient would direct you to vasculitis with deposits of immune complexes","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-12-qi-6","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"The ANCA result and urine strip are shown below. You think you need to:","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Perform an emergency kidney biopsy","justification":""},{"idx":1,"correct":false,"proposition":"Perform an arteriogram before renal biopsy","justification":""},{"idx":2,"correct":false,"proposition":"Contraindicate renal biopsy since ANCA are positive","justification":""},{"idx":3,"correct":true,"proposition":"Perform a kidney ultrasound before biopsy","justification":""},{"idx":4,"correct":false,"proposition":"Perform a uroscan before the biopsy","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-12-qi-7","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"You propose an emergency renal biopsy puncture. This will be carried out: ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Under general anesthesia","justification":"local"},{"idx":1,"correct":true,"proposition":"After obtaining the patient's blood type","justification":"It will be necessary to think about also ticking the RAI if they are proposed"},{"idx":2,"correct":true,"proposition":"With a non-fixed sample for immunofluorescence","justification":""},{"idx":3,"correct":false,"proposition":"Preferably scan-guided","justification":""},{"idx":4,"correct":false,"proposition":"With a sample for electron microscopy (EM)","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-12-qi-8","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"You receive the report of the ACB: ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"This is a histology compatible with pauci-immune vasculitis","justification":""},{"idx":1,"correct":false,"proposition":"The medullary part of the sample allowed the analysis of the glomeruli","justification":"This is the cortical part"},{"idx":2,"correct":false,"proposition":"There is mesangial proliferation","justification":"mesangium is fine"},{"idx":3,"correct":false,"proposition":"There are endomembranous deposits of imrrunoglobulins","justification":"All antibodies are negative"},{"idx":4,"correct":false,"proposition":"There are signs of vascular nephropathy","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-12-qi-9","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"This renal histology is consistent with pauciimmune vasculitis. You propose to treat the patient with: ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Venous corticosteroids","justification":""},{"idx":1,"correct":true,"proposition":"Plasmapheresis (plasma exchange)","justification":""},{"idx":2,"correct":true,"proposition":"Ivermectin","justification":""},{"idx":3,"correct":true,"proposition":"Cyclophosphamide","justification":""},{"idx":4,"correct":false,"proposition":"Aspirin anti-aggregating dose (AAP)","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-12-qi-10","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"In this context, you choose a therapeutic protocol combining cyclophosphamide, corticosteroid therapy and plasmapheresis. You want to inform the patient about the potential toxicities of cyciophosphamide. You explain the risk(s) of:","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Increased renal impairment","justification":""},{"idx":1,"correct":true,"proposition":"Hemorrhagic cystitis"},{"idx":2,"correct":true,"proposition":"Infection"},{"idx":3,"correct":true,"proposition":"Infertility"},{"idx":4,"correct":true,"proposition":"Myelodysplasia"}],"type":"dp"}
+{"_id":"annales-2018-dp-12-qi-11","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"You ask for a chest scan. In these images, you can distinguish: ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Cross-linking","justification":""},{"idx":1,"correct":true,"proposition":"Frosted glass","justification":""},{"idx":2,"correct":false,"proposition":"Excavated nodules","justification":""},{"idx":3,"correct":true,"proposition":"Condensations","justification":""},{"idx":4,"correct":false,"proposition":"From the honeycomb","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-12-qi-12","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"The patient's situation improves after 6 plasma exchanges, corticosteroid therapy (performed by infusion and then relayed at 1 mg \/ kg \/ day orally) and cyclophosphamide. You added cotrimoxazole (trimethoprim-sulfamethoxazole) at a dose appropriate to renal function on day one and the patient received ivennecline at an appropriate dose. It is apyretic, dyspnea has disappeared as well as ENT symptoms. Plasma creatinine stabilizes at 140 μmol\/L. CRP is less than 5 mg\/L. The patient's blood count, 2 weeks before the start of treatment, finds: PNN at 15.87 G \/ L, PNE at 0 G \/ L, PNB at 0 G \/ L, Lymphocytes at 0.84 G \/ L and Monocytes at 0.84 G \/ L. You think the results are related to: ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"a martial deficiency","justification":""},{"idx":1,"correct":true,"proposition":"cyclophosphamide","justification":""},{"idx":2,"correct":true,"proposition":"corticosteroid therapy","justification":""},{"idx":3,"correct":false,"proposition":"an infection","justification":""},{"idx":4,"correct":false,"proposition":"cotrimoxazole","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-12-qi-13","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"Twenty-eight days after the start of treatment, the patient presents with a rash of sudden onset whose photographs are shown to you. C-reactive protein, which was less than 5 mg\/L 72 hours previously, is at 115 mg\/L. Hemoglobin is at 13.5 g \/ dL, platelets at 480 G \/ L, leukocytes at 14 G \/ L (including 10 G \/ L neutrophils, 2 G \/ L eosinophils and 0.9 G \/ L lymphocytes), creatinine is stable at 140 μmol \/ L, AST are at 350 Ul \/ l, ALT at 390 IU \/ L,  gammaglutamyltransferases (GGT) at 390 IU\/L and alkaline phosphatases at 140 IU\/L. Emergency liver ultrasound is normal. You mention ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"A relapse of vasculitis","justification":""},{"idx":1,"correct":false,"proposition":"Generalized acute exanthematous pustulosis","justification":""},{"idx":1,"correct":true,"proposition":"A DRESS Syndrome","justification":""},{"idx":1,"correct":false,"proposition":"Angiocholitis","justification":""},{"idx":1,"correct":false,"proposition":"A parasitic infection on corticosteroids","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-12-qi-14","context":"Mr. N., 37 years old, is referred for an internal medicine consultation by an ENT colleague for a persistent fever. Mr. N. has no background, he works in an advertising company and has traveled extensively, including outside Europe. He has been the father for a month of a baby boy born at term without complications. He smokes regularly, at least ten cigarettes a day and consumes alcohol (2 to 3 drinks, once a week). The onset of symptoms dates back to 6 months before your consultation, with bilateral otitis. He then received a short course of corticosteroids and antibiotic therapy with amoxicillin and clavulanic acid. But the otitis recurred 2 weeks later, so he was treated with fluoroquinolones for 10 days. He then consulted a total of 6 times his ENT for these otitis (which the ENT confirmed on examination). During the last consultation, this ENT ordered a scan of the sinuses which was in favor of bilateral maxillary sinusitis. Due to the persistence of symptoms and a fever that has persisted for a month, the ENT colleague prefers to send it to you. He received a total of 6 times various antibiotics and 5 times a short course of corticosteroids. On the day of the consultation, the patient's temperature is 38.1°C.  The patient explains his story very clearly, telling you that with each treatment, the symptoms have improved for 10-15 days to return gradually. He had fever at home up to 38.5 ° C, regularly during these 6 months, bilateral otalgia, a feeling of blocked ear and nasal obstruction. He lost 3 kilograms in the last month, and weighs today 75 kilograms for a height of 176 centimeters. ","enonce":"You mention a synctome of hypersensitivity to cotrimoxazole that you stop immediately. The patient's vaccination record tells you that he received a BCG vaccination at 1 month of age (the subsequent tuberculin tests were all negative), a measles-mumps-rubella vaccination (2 injections), and a diphtheria-tetanus-pertussis-poliomyelitis vaccination whose last booster was made when the patient was 25 years old. He tells you that he has never had chickenpox. For prophylactic purposes, you advise vaccinating the patient with ","item":"annales-2018-dp-12","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"An influenza vaccination around October","justification":""},{"idx":1,"correct":true,"proposition":"An anti-pneumococcal vaccination with 2 injections","justification":""},{"idx":2,"correct":false,"proposition":"Vaccination against chickenpox","justification":""},{"idx":3,"correct":true,"proposition":"A DTP booster in the context of immunosuppression","justification":""},{"idx":4,"correct":false,"proposition":"A reminder from BCG","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-13-qi-1","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"Regarding legislation on sexual violence, what is the exact proposal(s)? ","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Rape is sexual assault","justification":""},{"idx":1,"correct":true,"proposition":"Forced fellatio can be considered rape","justification":""},{"idx":2,"correct":false,"proposition":"Rape does not exist between spouses","justification":""},{"idx":3,"correct":true,"proposition":"Rape is any act of sexual penetration carried out under threat, coercion or surprise","justification":"This is the definition in the Penal Code."},{"idx":4,"correct":false,"proposition":"A vulvar caress can be considered rape","justification":"No penetration = not rape."}],"type":"dp"}
+{"_id":"annales-2018-dp-13-qi-2","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"This girl is alone, tells you she is ashamed, and wishes that neither her parents nor anyone around her knew what happened. What is the course of action? (only one exact answer) ","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"You don't look at her until she files a complaint","justification":""},{"idx":1,"correct":true,"proposition":"You ask him to bring an adult of his choice to participate in his care","justification":""},{"idx":2,"correct":false,"proposition":"You tell his parents","justification":""},{"idx":3,"correct":false,"proposition":"You only do the integumentary examination but not the gynecological examination","justification":""},{"idx":4,"correct":false,"proposition":"You immediately notify the police","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-13-qi-3","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"The victim was joined by the 40-year-old mother of a friend. The victim asks you for a medical certificate. What is the exact proposal(s)? ","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"This document is essential if she wishes to file a complaint","justification":""},{"idx":1,"correct":true,"proposition":"You give him the medical certificate, in the presence of the adult of his choice","justification":""},{"idx":2,"correct":false,"proposition":"You give the medical certificate to the judicial police officer on duty at the police station","justification":""},{"idx":3,"correct":false,"proposition":"In case of judicial requisition, you give this certificate to the judicial police officer only if the young woman agrees","justification":""},{"idx":4,"correct":false,"proposition":"If the filing of a complaint is uncertain, the issuance of a medical certificate is not possible","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-13-qi-4","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"What is (are) the method(s) of drafting the medical certificate? ","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The medical editor mentions his identity","justification":""},{"idx":1,"correct":false,"proposition":"The victim must prove his identity to the doctor by giving him an identity document","justification":""},{"idx":2,"correct":false,"proposition":"The doctor certifies that the facts reported are credible","justification":""},{"idx":3,"correct":true,"proposition":"The absence of gynaecological traumatic injury must be mentioned in the certificate","justification":""},{"idx":4,"correct":false,"proposition":"Sexual violence results in total incapacity for work of more than eight days","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-13-qi-5","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"At the end of the clinical examination, which additional examination(s) do you request?","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Determination of b-HCG","justification":""},{"idx":1,"correct":true,"proposition":"HIV serology 1 and 2","justification":""},{"idx":2,"correct":true,"proposition":"HBV serology","justification":""},{"idx":3,"correct":true,"proposition":"HCV serology","justification":""},{"idx":4,"correct":true,"proposition":"Syphilis serology","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-13-qi-7","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"The information you give her persuades the girl to file a complaint to complete your judicial report. You contact the Police. The judicial police officer (OPJ) explains that a police team will come to bring you a document and wait at the hospital for the end of your examination. What is this document? (only one exact answer) ","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"An interim care order","justification":""},{"idx":1,"correct":false,"proposition":"A letter rogatory","justification":""},{"idx":2,"correct":false,"proposition":"A report of filing a complaint","justification":""},{"idx":3,"correct":true,"proposition":"A judicial requisition","justification":""},{"idx":4,"correct":false,"proposition":"An extract from the criminal record","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-13-qi-8","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"You are requisitioned by the judicial police officer to carry out the examination of the victim and any useful samples. In this context, what sample(s) can you carry out? ","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Bite swabs","justification":""},{"idx":1,"correct":true,"proposition":"Swabs at the vaginal level","justification":""},{"idx":2,"correct":true,"proposition":"Anal swabs","justification":""},{"idx":3,"correct":true,"proposition":"Swabs at the mouth level","justification":""},{"idx":4,"correct":false,"proposition":"Swabs from the nasal cavities","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-13-qi-9","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"At the end of your examination, the judicial police officer wants to know the number of days of total incapacity for work. Regarding total incapacity for work in the criminal sense for this patient, what is (are) the exact proposal(s)? ","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Total incapacity for work must be mentioned on the medical certificate","justification":""},{"idx":1,"correct":true,"proposition":"Total incapacity for work in the criminal sense corresponds to functional discomfort in carrying out the gestures of daily life","justification":""},{"idx":2,"correct":false,"proposition":"Total incapacity for work in the criminal sense corresponds to the number of days of absence from work","justification":""},{"idx":3,"correct":false,"proposition":"Total incapacity for work does not apply to minors","justification":""},{"idx":4,"correct":false,"proposition":"Total incapacity for work only makes sense if it is strictly greater than 8 days","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-13-qi-10","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"What treatment(s) can you urgently prescribe to this girl, with her agreement and that of the adult accompanying her? ","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"HPV vaccination","justification":""},{"idx":1,"correct":true,"proposition":"Triple anti-retroviral therapy","justification":""},{"idx":2,"correct":true,"proposition":"Emergency contraception","justification":""},{"idx":3,"correct":false,"proposition":"Antidepressant treatment that inhibits serotonin reuptake","justification":""},{"idx":4,"correct":true,"proposition":"Azithromycin antibiotic prophylaxis","justification":"In prevention of infection with Chlamydia trachomatis (in 2022, treatment is based on Doxycicline 8 days)."}],"type":"dp"}
+{"_id":"annales-2018-dp-13-qi-11","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"What element(s) should be included in the information to be provided to the victim? ","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Known side effects of treatments","justification":""},{"idx":1,"correct":true,"proposition":"Methods of monitoring processing","justification":""},{"idx":2,"correct":true,"proposition":"Risks in case of refusal of treatment","justification":""},{"idx":3,"correct":true,"proposition":"Contact details of a victim support association","justification":""},{"idx":4,"correct":true,"proposition":"The need for safe sex during HAART","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-13-qi-12","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"Four days later, the victim has side effects following taking triple antiretroviral therapy. She is furious because she says she was not informed of these effects. Regarding medical information, what is the exact proposal(s)? ","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"The burden of proof of information lies with the patient initiating a procedure","justification":""},{"idx":1,"correct":true,"proposition":"The information must be delivered orally","justification":""},{"idx":2,"correct":false,"proposition":"The information must be provided in writing","justification":"It is possible but not necessary."},{"idx":3,"correct":true,"proposition":"Information must be fair, clear and appropriate","justification":""},{"idx":4,"correct":false,"proposition":"A confirmation of the delivery of the information must be signed by the patient","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-13-qi-13","context":"A 17-year-old woman, found drunk in a downtown park, is brought to the emergency room by firefighters. She says she was raped by a stranger who appeared to be \"drugged\". She doesn't know if he was wearing a condom. On examination, carried out 12 hours after the fact, you notice centimetric rounded purplish bruises on the arms and forearms, two purplish bruises on the anterior surface of the thighs and an inflammatory dermabrasion, arciform, evoking a bite on the left arm. ","enonce":"The girl comes back to see you, pregnant with 9 weeks of amenorrhea, as a result of sexual violence, she tells you. What is the exact proposal(s) ","item":"annales-2018-dp-13","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Parental consent is required to carry out a voluntary termination of pregnancy","justification":""},{"idx":1,"correct":false,"proposition":"The girl may be accompanied by an adult of her choice for the different stages of the voluntary termination of pregnancy","justification":""},{"idx":2,"correct":false,"proposition":"The girl can benefit from a voluntary termination of pregnancy by medical means","justification":"The limit is 7 SA for the drug route. This duration may change in the coming months\/years, remember to check the latest recommendations of the HAS (and do not hesitate to let us know this proposal if it becomes true)."},{"idx":3,"correct":false,"proposition":"The girl can wait up to a term of 16 weeks of amenorrhea to request a voluntary termination of pregnancy","justification":""},{"idx":4,"correct":false,"proposition":"Due to the context, the cooling-off period is cancelled","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-14-qi-1","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"In the table of this patient, which of the following parameter(s) is (are) suggestive of sepsis with poor prognosis? ","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Temperature","justification":""},{"idx":1,"correct":true,"proposition":"Respiratory rate","justification":""},{"idx":2,"correct":false,"proposition":"Heart rate","justification":""},{"idx":3,"correct":false,"proposition":"Blood pressure","justification":""},{"idx":4,"correct":true,"proposition":"Score de Glasgow","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-14-qi-2","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"What is your immediate attitude? ","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"High concentration mask oxygen therapy","justification":""},{"idx":1,"correct":false,"proposition":"Establishment of a central venous first route","justification":""},{"idx":2,"correct":false,"proposition":"Filling with synthetic macromolecules (1L on the first hour)","justification":"Colloids are no longer used to fill patients (very limited indications in intensive care, this is not to be known for NEC)."},{"idx":3,"correct":false,"proposition":"Administration of vasopressive amines","justification":""},{"idx":4,"correct":false,"proposition":"Antibiotic therapy with ceftriaxone","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-14-qi-3","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"Which of the following exam(s) is part of your first-line assessment? ","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Chest X-ray","justification":""},{"idx":1,"correct":false,"proposition":"Bronchoalveolar lavage","justification":""},{"idx":2,"correct":false,"proposition":"Coproculture","justification":""},{"idx":3,"correct":true,"proposition":"Blood","justification":""},{"idx":4,"correct":true,"proposition":"Legionella antigenacuria","justification":"As well as pneumococcus"}],"type":"dp"}
+{"_id":"annales-2018-dp-14-qi-4","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"The CBC targets anemia at 121 g\/L, leukocytosis at 4600 G\/L (including 3800 PNN), CRP at 254 mg\/L and PCT at 3.5 μg\/L. The ionogram is normal, kidney function is normal. Arterial blood gases under nasal oxygen 6L\/min are: pH 7.45 - pC02 30 mmHg - p02 65 mmHg - HC03- 25 mmol \/ L. A chest CT scan is performed immediately. What is your interpretation of this scanner? ","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Interstitial syndrome","justification":""},{"idx":1,"correct":false,"proposition":"Pleural effusion","justification":""},{"idx":2,"correct":true,"proposition":"Alveolar condensation","justification":""},{"idx":3,"correct":false,"proposition":"Pericardial effusion","justification":""},{"idx":4,"correct":false,"proposition":"Caves","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-14-qi-5","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"Blood cultures are ongoing and legionella antigenuria is negative. Which of the following infectious agents may be responsible for this picture at this stage of your investigations?","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Streptococcus pneumoniae","justification":""},{"idx":1,"correct":true,"proposition":"Legionnella pneumophila","justification":"Which would be serotype 2 here (not detected by antigenuria, which can also be falsely negative)."},{"idx":2,"correct":false,"proposition":"Clostridium dificult","justification":""},{"idx":3,"correct":true,"proposition":"Pneumocystis jirovecii","justification":""},{"idx":4,"correct":true,"proposition":"Myxovirus influenzae","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-14-qi-6","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"The patient is immediately transferred to intensive care where he is immediately intubated in the face of respiratory exhaustion. Do you prescribe anti-infective treatment(s) at this stage?","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Cefotaxime","justification":""},{"idx":1,"correct":false,"proposition":"Amoxicillin","justification":""},{"idx":2,"correct":true,"proposition":"Spiramycin","justification":""},{"idx":3,"correct":true,"proposition":"Oseltamivir","justification":""},{"idx":4,"correct":false,"proposition":"Pristinamycin","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-14-qi-7","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"The probabilistic anti-infective treatment implemented combines cefotaxime, spiramycin and oseltamivir. A bronchoalveolar lavage is quickly performed. It highlights many cysts of Pneumocystis jirovecii. How do you adjust your treatment knowing that you are diagnosed with pneumocystosis? ","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Intravenous fluconazole","justification":""},{"idx":1,"correct":true,"proposition":"High-dose intravenous cotrimoxazole","justification":""},{"idx":2,"correct":false,"proposition":"Fidaxomicin aerosol","justification":""},{"idx":3,"correct":true,"proposition":"Corticosteroid therapy","justification":"PAO2 is less than 70 mmHg. Corticosteroid therapy will reduce fibrosis due to inflammatory overstimulation."},{"idx":4,"correct":false,"proposition":"Intravenous ketoprofen","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-14-qi-8","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"In view of this diagnosis, an HIV serology has been performed and is positive. What additional exam(s) do you perform?","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"CD4\/CD8 lymphocyte subpopulations","justification":""},{"idx":1,"correct":true,"proposition":"HIV viral load","justification":""},{"idx":2,"correct":false,"proposition":"Hepatitis E virus (HEV) serology","justification":""},{"idx":3,"correct":true,"proposition":"Toxoplasmosis serology","justification":""},{"idx":4,"correct":false,"proposition":"Syphilis serology","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-14-qi-9","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"With cotrimoxazole and corticosteroids, the patient's condition improves rapidly and he is extubated after 48 hours. He began to refeed orally. No other infectious agents were identified in all the samples taken. CD4 count is 19\/mm3 (4.8%) and viral load is 159,000 copies\/ml. On Day 4 of the management, concerning antiretroviral treatment, which of the following proposals is accurate? ","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Introduction of dual therapy with protease inhibitor and entry inhibitor","justification":""},{"idx":1,"correct":false,"proposition":"Introduction of triple therapy with protease inhibitors and two non-nucleoside reverse transcriptase inhibitors","justification":""},{"idx":2,"correct":false,"proposition":"Introduction of triple therapy with protease inhibitor and two nucleoside reverse transcriptase inhibitors","justification":""},{"idx":3,"correct":false,"proposition":"Introduction of triple therapy with integrase inhibitor and two nucleoside reverse transcriptase inhibitors","justification":""},{"idx":4,"correct":true,"proposition":"No antiretroviral therapy at this stage","justification":"We'll let him recover from his lung infection first ☺️"}],"type":"dp"}
+{"_id":"annales-2018-dp-14-qi-10","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"The trend continues to be favourable with cotrimoxazole. Corticosteroids were discontinued on Day 6 and antiretroviral therapy was not initiated. On Day 10 of the treatment, the fever reappears with a scarlatiniform rash of the trunk and face. What is (are) your hypothesis(s)? ","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Pneumocystis resistance to cotrimoxazole","justification":""},{"idx":1,"correct":true,"proposition":"Allergy to cortimoxazole","justification":""},{"idx":2,"correct":false,"proposition":"Rebound of pneumocystosis following discontinuation of corticosteroids","justification":""},{"idx":3,"correct":false,"proposition":"Immune restoration syndrome","justification":"Antiretrovirals have not yet been started."},{"idx":4,"correct":false,"proposition":"Staphylococcal toxic shock syndrome","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-14-qi-11","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"The hypothesis of an allergy to cotrimoxazole is retained. What sign(s) of gravity are you looking for? ","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Positive Nikolsky sign","justification":""},{"idx":1,"correct":false,"proposition":"Maculopapular rash","justification":"This is not especially a sign of gravity"},{"idx":2,"correct":true,"proposition":"Edema of the face","justification":""},{"idx":3,"correct":true,"proposition":"Associated mucosal erosions","justification":""},{"idx":4,"correct":false,"proposition":"Hearing loss","justification":"No report"}],"type":"dp"}
+{"_id":"annales-2018-dp-14-qi-12","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"There is no sign of severity and the rash regresses within a few days following the reduction of cotrimoxazole doses. You decide on Day 15 to introduce antiretroviral treatment. Which of the following will be useful for the choice of initial antiretroviral therapy? ","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Search for the HLA B57*01 allele","justification":""},{"idx":1,"correct":true,"proposition":"Genotypic HIV resistance test","justification":""},{"idx":2,"correct":true,"proposition":"Hepatitis B serology","justification":""},{"idx":3,"correct":false,"proposition":"Syphilis serology","justification":""},{"idx":4,"correct":false,"proposition":"Plasma testing of antiretrovirals","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-14-qi-13","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"The result of HBV serology is as follows: HBsAg positive, HBeAg positive, anti-HBc IgM negative, anti-HBc IgG positive, anti-HBe antibodies and HBs negative. HBV DNA PCR is high (10 million Ul\/ml) and transaminases are 2.5 times the norm. Which of the following is correct?","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"It is probably acute hepatitis B","justification":""},{"idx":1,"correct":true,"proposition":"It is a hepatitis B virus without pre-core mutation","justification":"The HBe antigen is positive so it is not mutated"},{"idx":2,"correct":true,"proposition":"Antiretroviral therapy should ideally include tenofovir","justification":""},{"idx":3,"correct":false,"proposition":"Ribavirin should be added to antiretroviral therapy","justification":"ribavirin is active against HCV"},{"idx":4,"correct":false,"proposition":"HBV serovaccination should also be given to the patient","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-14-qi-14","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"Triple antiretroviral therapy is initiated on Day 15. Which of the following proposals for support after D15 is correct? ","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Continuation of cotrimoxazole treatment at current doses for another week","justification":""},{"idx":1,"correct":true,"proposition":"Secondary prophylaxis (after the end of attack therapy) low-dose anti-pneumocystosis ar cotrimoxazole","justification":""},{"idx":2,"correct":false,"proposition":"Initiation of primary prophylaxis of esophageal candidiasis with fluconazole","justification":""},{"idx":3,"correct":false,"proposition":"Initiation of primary anti-toxoplasmosis prophylaxis with low-dose pyrimethamine","justification":""},{"idx":4,"correct":false,"proposition":"Maintenance of primary toxoplasmosis and secondary pneumocystosis prophylaxis for 2 years","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-14-qi-15","context":"A 41-year-old man was referred to the Emergency Department on December 24 for fever, deterioration of the general condition, and acute respiratory distress. His main antecedents are treated high blood pressure, and chronic alcohol withdrawal since 2016. The story began two weeks ago with a cough resistant to symptomatic treatment, for which treatment with amoxicillin-clavulanic acid was initiated 7 days ago by his attending physician. He then presented with diarrhea and dyspnea of exertion for 3 days. His condition deteriorated very rapidly the previous night with acute respiratory distress. On arrival, the patient presents generalized mottling, labial and nail cyanosis, chills and fever at 39 ° C, respiratory rate at 43 \/ min, heart rate at 110 \/ min, blood pressure at 105\/70 mmHg. His Glasgow score is rated at 13. ","enonce":"What other measure(s) can you personally take? ","item":"annales-2018-dp-14","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Information for sexual partners","justification":""},{"idx":1,"correct":false,"proposition":"Nominative declaration to the ARS","justification":"anonymous"},{"idx":2,"correct":true,"proposition":"Declaration of long-term illness (100%)","justification":"ALD 7"},{"idx":3,"correct":false,"proposition":"Declaration to occupational medicine","justification":""},{"idx":4,"correct":true,"proposition":"Proposal for psychological follow-up","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-15-qi-1","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"Which lesional location(s) do you think are likely? ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Left Thalamic","justification":""},{"idx":1,"correct":true,"proposition":"Left frontal","justification":""},{"idx":2,"correct":false,"proposition":"Right midbrain","justification":""},{"idx":3,"correct":false,"proposition":"Left Capsular","justification":""},{"idx":4,"correct":true,"proposition":"Left parietal","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-15-qi-2","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"What is your immediate care ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Realization of a Doppler ultrasound of the supra-aortic trunks","justification":""},{"idx":1,"correct":true,"proposition":"Support by the neurovascular sector","justification":""},{"idx":2,"correct":true,"proposition":"Performing a brain MRI","justification":""},{"idx":3,"correct":false,"proposition":"Initiation of antihypertensive therapy","justification":"High blood pressure figures are tolerated in ischemic stroke."},{"idx":4,"correct":false,"proposition":"Initiation of antiplatelet therapy","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-15-qi-3","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"What sequence(s) should the MRI include? ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"T1 with gadolinium injection","justification":""},{"idx":0,"correct":false,"proposition":"T2","justification":""},{"idx":0,"correct":true,"proposition":"T2 FLAIR","justification":""},{"idx":0,"correct":true,"proposition":"Broadcast sequence (DWI)","justification":""},{"idx":0,"correct":true,"proposition":"3D TOF (angio-MRI, Time Of Flight)","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-15-qi-4","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"Here are two images of the MRI performed: ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Left sylvian hypersignal in FLAIR sequence","justification":""},{"idx":1,"correct":true,"proposition":"Right occipital hypersignal in FLAIR sequence","justification":""},{"idx":2,"correct":true,"proposition":"Left sylvian hypersignal in diffusion sequence","justification":""},{"idx":3,"correct":false,"proposition":"Right silvian hypersignal in diffusion sequence","justification":""},{"idx":4,"correct":false,"proposition":"Left sylvian hyposignal in scattering sequence","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-15-qi-5","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"Brain MRI reveals a recent lesion visible in diffusion sequence in the superficial left sylvian territory. It also finds a hypersignal in FLAIR sequence in the right, ancient occipital territory. There is no bleeding lesion or obstruction of the proximal large vessels. In view of these MRI results and the clinical context, which pathophysiological hypothesis do you think is most likely? (only one answer expected) ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Left carotid dissection","justification":""},{"idx":1,"correct":false,"proposition":"Microangiopathy","justification":""},{"idx":2,"correct":false,"proposition":"Cerebral arteritis","justification":""},{"idx":3,"correct":true,"proposition":"Embologenic heart disease","justification":""},{"idx":4,"correct":false,"proposition":"Atheroma","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-15-qi-6","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"What is your immediate therapeutic proposal? (only one answer expected) ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Parenteral antiplatelet agents","justification":""},{"idx":1,"correct":false,"proposition":"Unfractionated parenteral hypocoagulant heparin","justification":""},{"idx":2,"correct":false,"proposition":"New oral anticoagulants","justification":""},{"idx":3,"correct":true,"proposition":"Intravenous thrombolysis by rt PA","justification":""},{"idx":4,"correct":false,"proposition":"Thrombectomy","justification":"We are not in a case of late time. In addition, the clot is not proximal, which would make thrombectomy complicated."}],"type":"dp"}
+{"_id":"annales-2018-dp-15-qi-7","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"Following the MRI, the patient was admitted to the neurovascular unit (UNV) and underwent intravenous thrombotyposis. The motor deficit has partially recovered, phasic disorders persist. What is(are) the element(s) of your prescription during the first 24 hours? ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Antihypertensive treatment","justification":""},{"idx":1,"correct":false,"proposition":"Lift allowed","justification":""},{"idx":2,"correct":true,"proposition":"Subcutaneous insulin therapy if blood glucose above 1.8 g\/L","justification":""},{"idx":3,"correct":false,"proposition":"Transcranial Doppler","justification":""},{"idx":4,"correct":true,"proposition":"Multiple daily clinical monitoring by NIHSS score","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-15-qi-8","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"At 48 hours of evolution, the patient remains aphasiac. There persists a predominant distal right brachial motor deficit and oral feeding is resumed without discomfort. He did not present any complications. What is (are) the objective(s) of physiotherapy management at this stage? ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Analytical reinforcement of motor skills","justification":""},{"idx":1,"correct":false,"proposition":"Breathing decluttering exercises","justification":""},{"idx":2,"correct":false,"proposition":"Sensory awakening work","justification":""},{"idx":3,"correct":false,"proposition":"Deep transverse massages","justification":""},{"idx":4,"correct":false,"proposition":"Passive mobilizations of the lower right limb","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-15-qi-9","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"To confirm your main etiological hypothesis, you prescribe ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"A Doppler ultrasound of the supra-aortic trunks","justification":""},{"idx":1,"correct":true,"proposition":"A trans-thoracic cardiac ultrasound","justification":""},{"idx":2,"correct":true,"proposition":"Transesophageal cardiac ultrasound","justification":""},{"idx":3,"correct":true,"proposition":"An ECG holter","justification":""},{"idx":4,"correct":false,"proposition":"A tensional holter","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-15-qi-10","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"This patient has Broca's aphasia. Which characteristic(s) are compatible with this diagnosis?","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Presence of paraphasies"},{"idx":1,"correct":true,"proposition":"Impaired fluence"},{"idx":2,"correct":true,"proposition":"Normal comprehension"},{"idx":3,"correct":false,"proposition":"Normal written expression"},{"idx":4,"correct":false,"proposition":"Agnosia"}],"type":"dp"}
+{"_id":"annales-2018-dp-15-qi-11","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"The holter ECG shows paroxysmal atrial fibrillation. Cardiac ultrasound (transthoracic and transesophageal) and Doppler ultrasound of the supraaortic trunks are normal. The lipid and glycemic balance is normal. Blood pressure normalized. What is (are) the element(s) of your exit prescription? ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"ACE inhibitor","justification":""},{"idx":1,"correct":false,"proposition":"Statine","justification":""},{"idx":2,"correct":true,"proposition":"Oral anticoagulant","justification":""},{"idx":3,"correct":false,"proposition":"Antiplatelet agent","justification":""},{"idx":4,"correct":false,"proposition":"Loop diuretic","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-15-qi-12","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"What is(are) your non-drug prescription (s)? ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Speech therapy","justification":""},{"idx":1,"correct":true,"proposition":"Work stoppage","justification":""},{"idx":1,"correct":false,"proposition":"First category invaladity","justification":"Not acute because the patient can continue to recover"},{"idx":1,"correct":false,"proposition":"Safeguarding justice","justification":""},{"idx":1,"correct":true,"proposition":"Physiotherapy assessment","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-15-qi-13","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"You see the patient again in follow-up consultation at 3 months. There is still clumsiness in the right hand and a reduction in fluency, as well as fatigability. He is autonomous for most activities of daily living but has not been able to resume his professional activity. He also complains of attention and sleep disorders, his weight is 65 kg. He continues his anticoagulantoral treatment with anti-vitamin K. What is your diagnostic orientation in the face of this clinical evolution (only one expected response) ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Recurrent ischemic stroke","justification":""},{"idx":1,"correct":false,"proposition":"Side effects of drug treatment","justification":""},{"idx":2,"correct":false,"proposition":"Vascular epilepsy","justification":""},{"idx":3,"correct":true,"proposition":"Depressive syndrome","justification":""},{"idx":4,"correct":false,"proposition":"Deficiency","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-15-qi-14","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"What medico-social measure(s) can you propose? ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Constitution of a file with the Departmental House of Disabled Persons for allocation of the Disabled Adult Allowance (AAH)","justification":""},{"idx":1,"correct":true,"proposition":"Preparation of a file with the Departmental House of Persons with Disabilities for recognition of quality disabled worker","justification":""},{"idx":2,"correct":false,"proposition":"First category invaladity","justification":""},{"idx":2,"correct":true,"proposition":"Renewal of the stoppage of work","justification":""},{"idx":2,"correct":false,"proposition":"Declaration of occupational disease","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-15-qi-15","context":"At 5:30 p.m., you will take charge of a 57-year-old patient in the emergency department, with a family history of myocardial infarction in the father and non-insulin-dependent diabetes in the mother, without personal history or toxic habits, employed in a masonry company. He does not receive long-term treatment. He presented suddenly at 4 p.m. a phasic disorder of expression and a right hemibody motor deficit predominantly brachiofacial that persist. This right-handed patient weighs 71 kg for 180 cm. Its voltage is 170\/100 mm Hg. His pulse is 75\/min, regular. You suspect an ischemic stroke. ","enonce":"Regarding his long-term oral anticoagulant treatment, which is(are) the exact proposal(s)? ","item":"annales-2018-dp-15","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"The target INR is between 2.5 and 3.5","justification":""},{"idx":1,"correct":true,"proposition":"The INR control must be at least monthly","justification":""},{"idx":2,"correct":true,"proposition":"An INR around 2 allows dental care","justification":""},{"idx":3,"correct":true,"proposition":"In case of hemorrhage, PPSB acts faster than vitamin K","justification":""},{"idx":4,"correct":false,"proposition":"In case of INR at 5, vitamin K intake is recommended","justification":"If he is asymptomatic, he simply has to skip a catch."}],"type":"dp"}
+{"_id":"annales-2018-dp-16-qi-1","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"What diagnosis(s) do you suspect? ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Guttate psoriasis","justification":""},{"idx":1,"correct":false,"proposition":"Erythema multiforme","justification":""},{"idx":2,"correct":false,"proposition":"Primary HIV infection","justification":""},{"idx":3,"correct":true,"proposition":"Secondary syphilis","justification":""},{"idx":4,"correct":false,"proposition":"Dermatophytia","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-16-qi-2","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"You suspect secondary syphilis. Which symptom(s) or examination sign(s) presented by the patient is (are) suggestive with this diagnosis? ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The localization on the trunk of the eruption","justification":""},{"idx":1,"correct":true,"proposition":"Asthenia","justification":""},{"idx":2,"correct":true,"proposition":"Polyadenopathy","justification":""},{"idx":3,"correct":true,"proposition":"Transient nature of trunk rash","justification":""},{"idx":4,"correct":false,"proposition":"Apyrexia","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-16-qi-3","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"Which of the following symptoms can also be highlighted in secondary syphilis? ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Polyarthralgia","justification":""},{"idx":1,"correct":true,"proposition":"Facial paralysis","justification":""},{"idx":2,"correct":true,"proposition":"Hearing loss","justification":""},{"idx":3,"correct":true,"proposition":"Uveitis","justification":"This is the famous 'big simulator'"},{"idx":4,"correct":false,"proposition":"Recurrent cystitis","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-16-qi-4","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"To reinforce your diagnosis, you look for the existence of symptomatic primary syphilis that preceded the current rash. Which of the following proposals for syphilitic chancro is (are) accurate? ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"It is painful","justification":""},{"idx":1,"correct":true,"proposition":"It is most often unique","justification":""},{"idx":2,"correct":true,"proposition":"It is accompanied by lymphadenopathy","justification":""},{"idx":3,"correct":false,"proposition":"It is soft in consistency","justification":"It is endured"},{"idx":4,"correct":true,"proposition":"It can be of pharyngeal localization","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-16-qi-5","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"You do not find at the interrogation any element in favor of a syphilitic chancre. The patient informs you, however, that he was diagnosed with syphilis 10 years ago and that he received treatment. Which of the following tests do you request to confirm the diagnosis of secondary syphilis?","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"TPHA","justification":""},{"idx":1,"correct":false,"proposition":"Blood count","justification":""},{"idx":2,"correct":false,"proposition":"Skin biopsy","justification":""},{"idx":3,"correct":true,"proposition":"VDRL","justification":""},{"idx":4,"correct":false,"proposition":"Cultivation of a swab made on the palm","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-16-qi-6","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"The TPHA is positive (+++) and the VDRL is 1\/64. In context, what interpretation(s) do you make of it? ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Previously treated syphilis serological scar","justification":""},{"idx":1,"correct":false,"proposition":"Very early syphilis","justification":""},{"idx":2,"correct":false,"proposition":"False positive","justification":""},{"idx":3,"correct":true,"proposition":"Untreated secondary syphilis","justification":""},{"idx":4,"correct":false,"proposition":"Non-venereal treponematosis","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-16-qi-7","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"Apart from syphilis, what is the situation(s) where a VDRL can be positive?","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Lupus","justification":""},{"idx":1,"correct":true,"proposition":"Anti-phospholipid antibody syndrome","justification":""},{"idx":2,"correct":true,"proposition":"Non-venereal treponematosis","justification":""},{"idx":3,"correct":true,"proposition":"Leprosy","justification":""},{"idx":4,"correct":true,"proposition":"Borreliosis","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-16-qi-8","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"Apart from syphilis, what is the situation(s) where APHD can be positive? ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Lupus","justification":""},{"idx":1,"correct":false,"proposition":"Anti-phospholipid antibody syndrome","justification":""},{"idx":2,"correct":true,"proposition":"Non-venereal treponematosis","justification":""},{"idx":3,"correct":false,"proposition":"Leprosy","justification":""},{"idx":4,"correct":false,"proposition":"Borreliosis","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-16-qi-9","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"You are looking for another sexually transmitted disease(s) in this patient. Which exam(s) are you requesting? ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Hepatitis B serology","justification":""},{"idx":1,"correct":false,"proposition":"Serology Mycoplasma hominis","justification":"We don't track that"},{"idx":2,"correct":false,"proposition":"Serology Chlamydia trachomatis","justification":"Is done by PCR"},{"idx":3,"correct":false,"proposition":"Serology Neisseria gonorrhoae","justification":"Is done by PCR"},{"idx":4,"correct":true,"proposition":"HIV serology","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-16-qi-10","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"Because the patient is HIV-negative, what treatment(s) do you put in place, in the absence of drug allergy, to treat secondary syphilis?","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Ceftriaxone 500 mg, single intramuscular administration","justification":"Treatment of gonococci"},{"idx":1,"correct":false,"proposition":"Azithromycin 1 g, single oral administration","justification":"Treatment of Chlamydia trachomatis (today it is Doxycicline 8 days in first line)"},{"idx":2,"correct":true,"proposition":"Benzathine benzylpenicillin G 2.4 MUI, single intramuscular administration","justification":""},{"idx":3,"correct":false,"proposition":"Penicillin G 20 MUI, intravenous administration for 15 days","justification":"Neurosyphilis"},{"idx":4,"correct":false,"proposition":"Doxycycline 200 mg, single oral administration","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-16-qi-11","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"The patient received a single injection of benzathine benzylpeflicillin G 2.4 MUI. A few hours later, he complained of headaches and myalgia. The temperature is 38°C and lesions on the palms and plants appear more numerous and larger. What diagnosis(s) do you mention? ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Drug urticaria","justification":""},{"idx":1,"correct":false,"proposition":"Fixed pigmented erythema","justification":""},{"idx":2,"correct":false,"proposition":"Taxidermy with macula-papular exanthema type","justification":""},{"idx":3,"correct":true,"proposition":"Reaction to treponeme lysis","justification":""},{"idx":4,"correct":false,"proposition":"Drug-induced hypersensitivity syndrome (DRESS)","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-16-qi-12","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"In order to ensure the effectiveness of benzathine benzylpenicillin G 2,4 MIU treatment, when should you recheck TPHA and VDRL in this patient? (one or more correct answers) ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"15 days","justification":""},{"idx":1,"correct":false,"proposition":"1 month","justification":""},{"idx":2,"correct":false,"proposition":"Serological monitoring is not necessary","justification":""},{"idx":3,"correct":true,"proposition":"6 months","justification":""},{"idx":4,"correct":true,"proposition":"1 year","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-16-qi-13","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"The questioning of the patient taught you about the existence of several partners in the previous months, without protection from sexual intercourse. Only his most recent partner was able to be contacted by the patient and present for consultation. The last unprotected sex between them was 3 weeks ago. TPHA and VDRL are negative. What is the possible interpretation(s) of the partner's serology? ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":" Absence of syphilis","justification":""},{"idx":1,"correct":true,"proposition":"Very recent syphilis","justification":""},{"idx":2,"correct":false,"proposition":"Secondary syphilis","justification":""},{"idx":3,"correct":false,"proposition":"Tertiary syphilis","justification":""},{"idx":4,"correct":false,"proposition":"Non-venereal treponematosis","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-16-qi-14","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"What can you offer this partner? ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"A serological check 3 months later","justification":""},{"idx":1,"correct":true,"proposition":"An injection of benzathine benzylpenicillin G, after checking for allergy","justification":""},{"idx":2,"correct":false,"proposition":"Serological control is not necessary","justification":""},{"idx":3,"correct":true,"proposition":"Protected sex","justification":""},{"idx":4,"correct":false,"proposition":"Sexual abstinence","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-16-qi-15","context":"A 39-year-old man consults for a palmoplantar rash that began 6 months ago (Figure 1). He initially described a diffuse eruption of the trunk, having gradually amended. He complains of asthenia that began at the same time as the rash and reports no weight loss. The clinical examination shows a temperature of 36 ° 8 C and a symmetrical inguinal and cervical centimetric polyadenopathy. The examination of the mucous membranes is unremarkable. ","enonce":"You see the patient again 6 months after treatment of secondary syphilis with benzathine benzylpenicillin G 2.4 M. It is asymptomatic and the rash is gone. The VDRL is 1\/16, the TPHA is positive (+). As a reminder, in pre-therapeutics, the TPHA was positive (+++) and the VDRL was 1\/64. What interpretation(s) do you make? ","item":"annales-2018-dp-16","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Recontamination","justification":""},{"idx":1,"correct":false,"proposition":"Treatment resistance","justification":""},{"idx":2,"correct":true,"proposition":"Healing","justification":""},{"idx":3,"correct":false,"proposition":"Non-venereal treponematosis","justification":""},{"idx":4,"correct":false,"proposition":"Need for a new injection of benzathine benzylpenicillin G 2,4 MIU","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-17-qi-1","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"Which additional exam(s) are you considering? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Serum vitamin B12 assay","justification":""},{"idx":1,"correct":true,"proposition":"Reticulocyte count","justification":""},{"idx":2,"correct":true,"proposition":"Myelogram","justification":"The statement does not speak of first intention, so it is true since the myelogram is well envisaged in the prse in charge of a potentially central anemia."},{"idx":3,"correct":false,"proposition":"Tongue biopsy","justification":""},{"idx":4,"correct":true,"proposition":"Serum vitamin 89","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-17-qi-2","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"The reticulocyte count is 70 OOO\/mm3. A myelogram is performed. The examination finds the presence of a rich marrow, with erythroblasts of large size, an asynchrony of nucleocytoplasmic maturation, the presence of giant metamyelocytes and hypersegmented polynuclear cells. There is no excess of blasts. What is your diagnosis? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Myelodysplastic syndrome","justification":""},{"idx":1,"correct":false,"proposition":"Acute leukemia","justification":""},{"idx":2,"correct":false,"proposition":"Bone marrow suppression","justification":""},{"idx":3,"correct":true,"proposition":"Megaloblastic anemia","justification":""},{"idx":4,"correct":false,"proposition":"Anemia","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-17-qi-3","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"The requested assessment finds a serum concentration of vitamin B12 at 75 ng \/ L (N>200). The dosage of vitamin B9 is normal. Which additional exam(s) do you prescribe to complete the assessment? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Determination of anti-transglutaminase antibodies","justification":""},{"idx":1,"correct":false,"proposition":"Determination of anti-nuclear antibodies","justification":""},{"idx":2,"correct":false,"proposition":"Enteroscanner with contrast injection","justification":""},{"idx":3,"correct":true,"proposition":"Determination of anti-intrinsic factor antibodies","justification":""},{"idx":4,"correct":true,"proposition":"Upper GI endoscopy","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-17-qi-4","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"Anti-intrinsic factor antibodies are absent and upper gastrointestinal endoscopy finds pallor of the mucous membrane of the antrum and gastric body with excessive visibility of the small vessels. There is no esophagitis. Samples taken from the gastric body and the antrum reveal a rarefaction of the density of the glands with the presence of sectors of the epithelium consisting of intestinal type cells. Absence of visible pathogen. There is in the chorion a moderate lymphoplasmacytic infiltrate without neutrophil polynuclear. What is the real proposal(s)? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Pangastric glandular atrophy","justification":""},{"idx":1,"correct":true,"proposition":"Biermer's disease","justification":""},{"idx":2,"correct":false,"proposition":"Lymphocytic gastritis","justification":""},{"idx":3,"correct":false,"proposition":"Active inflammatory gastritis","justification":""},{"idx":4,"correct":true,"proposition":"Chronic gastritis with intestinal metaplasia","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-17-qi-5","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"What is (are) in this patient the predisposing factor(s) to this atrophic pangastritis with intestinal metaplasia? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"An autoimmune pathology","justification":""},{"idx":0,"correct":true,"proposition":"the sequelae of a Helicobacter pylori infection","justification":""},{"idx":0,"correct":true,"proposition":"Tobacco","justification":""},{"idx":0,"correct":false,"proposition":"An autoimmune pathology","justification":""},{"idx":0,"correct":false,"proposition":"Taking proton pump inhibitors","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-17-qi-6","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"What consequence(s) does this atrophic gastritis with intestinal metaplasia expose? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Risk of gastric adenocarcinoma","justification":""},{"idx":1,"correct":true,"proposition":"Iron deficiency","justification":""},{"idx":2,"correct":false,"proposition":"Gastric lymphoma","justification":""},{"idx":3,"correct":false,"proposition":"Duodenal ulcer","justification":""},{"idx":4,"correct":true,"proposition":"Gastric ulcer","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-17-qi-7","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"Seven years later, the then 58-year-old patient consulted the Emergency Department for ascites of progressive onset within 15 days. It has appeared for 3 years a non-insulin-requiring diabetes treated with metformin. He drinks about 2 bottles of wine a day. The patient always takes esomeprazole 40 mg daily and an IM injection of vitamin 812 every month. No control endoscopy was performed. The biological assessment shows: Leukocyles at 7700\/mm3, neutrophils at 3200\/mm3, polynuclear eosinophils at 200\/mm3, lymphocytes at 3500\/mm3, hemoglobin at 9.3 g\/dL, MCV at 82 μ3 platelets at 110 0OO\/mm3, AST at 56 IU (N<40), ALT at 43 IU (N<40), TP at 54%, Total bilirubinemia at 87 μmol\/l. You perform an ascites puncture of which here are the results: proteins at 15g \/ L and elements: 500 \/ mm3 including 70% neutrophils, 20% lymphocytes, 10% monocytes. What diagnosis do you make?","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Peritoneal carcinomatosis"},{"idx":1,"correct":true,"proposition":"Ascites fluid infection on cirrhosis","justification":"Because PNN > 250\/mm3"},{"idx":2,"correct":false,"proposition":"Peritoneal tuberculosis"},{"idx":3,"correct":false,"proposition":"Rupture of a pancreatic pseudocyst","justification":""},{"idx":4,"correct":false,"proposition":"Rupture of hepatocellular carcinoma in the peritoneum","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-17-qi-8","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"You are diagnosed with ascites fluid infection. Which probabilistic antibiotic therapy(s) is\/are recommended as a first-line treatment? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Amoxicillin-clavulanic acid","justification":"Possible oral alternative"},{"idx":1,"correct":false,"proposition":"Vancomycin","justification":""},{"idx":2,"correct":false,"proposition":"Amikacin","justification":""},{"idx":3,"correct":false,"proposition":"Erythromycin","justification":""},{"idx":3,"correct":true,"proposition":"Cefotaxime","justification":"In the first intention"}],"type":"dp"}
+{"_id":"annales-2018-dp-17-qi-9","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"How will you confirm the diagnosis of cirrhosis with certainty in this patient? (one or more correct answers) ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Non-invasive fibrosis test","justification":""},{"idx":1,"correct":true,"proposition":"Hepatic ultrasound","justification":""},{"idx":2,"correct":false,"proposition":"Liver biopsy under ultrasound control","justification":"Contraindicated by ascites"},{"idx":3,"correct":true,"proposition":"Transjugular liver biopsy","justification":"Confirmatory diagnosis of cirrhosis is histological"},{"idx":4,"correct":false,"proposition":"Liver CT scan","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-17-qi-10","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"As part of the screening for viral hepatitis, what test(s) do you perform on this patient?","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Serology of viral hepatitis A","justification":""},{"idx":1,"correct":true,"proposition":"HBs antigen"},{"idx":2,"correct":true,"proposition":"Serology of viral hepatitis C (HCV)","justification":""},{"idx":3,"correct":false,"proposition":"Hepatitis B virus viral load","justification":""},{"idx":4,"correct":true,"proposition":"Hepatitis C virus viral load","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-17-qi-11","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"The evolution of the episode is favorable under antibiotics. The patient no longer has ascites. You set up a long-term follow-up. What measure(s) do you propose? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Screening for hepatocellular carcinoma","justification":""},{"idx":1,"correct":true,"proposition":"Screening for portal hypertension","justification":""},{"idx":2,"correct":true,"proposition":"Secondary prevention of ascites fluid infection","justification":""},{"idx":3,"correct":true,"proposition":"Screening for ENT cancers","justification":""},{"idx":4,"correct":true,"proposition":"Gastric cancer screening","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-17-qi-12","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"How do you screen for hepatocellular carcinoma (single response)? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Liver ultrasound every 6 months","justification":""},{"idx":1,"correct":false,"proposition":"Liver ultrasound every year","justification":""},{"idx":2,"correct":false,"proposition":"Liver CT scan every 6 months","justification":""},{"idx":3,"correct":false,"proposition":"Liver scan every year","justification":""},{"idx":4,"correct":false,"proposition":"Serum alpha-fetoprotein assay annually","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-17-qi-13","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"During follow-up, a 2 cm segment IV hepatic nodule is highlighted. You perform a CT scan to characterize it. What CT characteristic(s) are you looking for in favor of hepatocellular carcinoma? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Spontaneously hyperdense","justification":""},{"idx":1,"correct":true,"proposition":"Spontaneously hypodense","justification":""},{"idx":2,"correct":true,"proposition":"Contrast taking at arterial time","justification":""},{"idx":3,"correct":false,"proposition":"Hyperdensity at portal time","justification":"Hypodensity (washing, wash-out)"},{"idx":4,"correct":true,"proposition":"Hypodensity at portal time","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-17-qi-14","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"The CT scan reveals a spontaneously hypodense tumor, taking the contrast at arterial time and washing at portal time. The diagnosis of hepatocellular carcinoma is made. Which first-line treatment(s) will be discussed? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Hepatic resection","justification":""},{"idx":1,"correct":false,"proposition":"Intravenous chemotherapy","justification":""},{"idx":2,"correct":false,"proposition":"Intra-arterial chemotherapy","justification":""},{"idx":3,"correct":true,"proposition":"Percutaneous ablation","justification":"By radio frequency"},{"idx":4,"correct":false,"proposition":"External beam radiation therapy","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-17-qi-15","context":"A 52-year-old man comes to consult you for a loss of taste of food for several weeks. During interrogation, hot or spicy foods cause a burning sensation on the tongue. The patient also perceives a feeling of numbness of the tongue. You also notice manifestations of pyrosis after meals. The patient has lost 6 kg for 10 monthsIt weighs 72 kg for 1m70. He notes rapid shortness of breath during small efforts. On clinical examination, the tongue has a depapillated appearance and its surface is smooth. You notice the presence of millimeter linear erosions on its edge. The patient is pale. The patient takes only 40 mg of esomeprazole every 3 days on average. He was also transfused in 1982 following a road accident complicated by an open leg fracture. An upper endoscopy was performed about ten years earlier. It was normal according to the patient who no longer has the report. His tobacco consumption is estimated at 40 packs-year, he drinks about a bottle of wine a day. The biological balance shows: Leukocytes=4500\/mm3, Polynuclear neutrophils=2200\/mm3, Polynuclear eosinophils=100\/mm3 Basophilic polynuclears=0\/mm3,Lymphocytes=1700\/mm3Monocytes=500\/mm3,Hemoglobin=9.2g\/dL,VGM=118µ3, platelets=150000\/mm3. The blood ionogram and kidney function are normal.","enonce":"The patient is treated with radiofrequency. Two years later, his liver function deteriorated with the onset of refractory ascites. He also has a recurrence of his hepatocellular carcinoma as a new 3 cm nodule. He is 62 years old and you mention the possibility of a liver transplant. What are the prerequisites? ","item":"annales-2018-dp-17","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Effective alcohol withdrawal","justification":""},{"idx":1,"correct":false,"proposition":"Effective smoking cessation","justification":""},{"idx":2,"correct":true,"proposition":"Absence of extrahepatic cancer","justification":""},{"idx":3,"correct":true,"proposition":"Absence of extrahepatic metastasis of hepatocellular carcinoma","justification":""},{"idx":4,"correct":false,"proposition":"Absence of endoscopic portal hypertension","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-18-qi-1","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"Which of the following diagnoses can explain this picture? ","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Attention deficit disorder with or without hyperactivity","justification":""},{"idx":1,"correct":true,"proposition":"Characterized depressive episode","justification":""},{"idx":2,"correct":true,"proposition":"Hypochondria","justification":""},{"idx":3,"correct":false,"proposition":"Conversion hysteria","justification":""},{"idx":4,"correct":true,"proposition":"Persistent delusional disorder of somatic type","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-18-qi-2","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"At Mrs. B's insistence, the general practitioner finally agreed to prescribe a brain scan without injection. In the event of hypochondria (or excessive fear of having a disease), indicate the exact proposal(s). ","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The prescription of this examination may maintain the disorder","justification":""},{"idx":1,"correct":false,"proposition":"The normality of this examination will provide lasting reassurance to the patient.","justification":""},{"idx":2,"correct":false,"proposition":"The normality of this examination is necessary to confirm the diagnosis","justification":""},{"idx":3,"correct":false,"proposition":"An abnormality on this examination would rule out the diagnosis of hypochondria","justification":""},{"idx":4,"correct":true,"proposition":"The doctor-patient relationship may have influenced this prescribing decision","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-18-qi-3","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"The brain scan without injection performed during the week shows no abnormalities. Mrs. B consults the same doctor again and asks him to prescribe this examination again. She considers it to be << false results >> and explains that they want to make <<her look crazy but that they have not closed everything >>. Mrs. B states that she has a metal object in her brain following surgery. This object is not mentioned in the report of the scanner, so it would be according to her images of someone else. She wants to perform a new scanner in another radiology practice. We note in the words of Mrs. B.: ","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"A tendency to mythomania","justification":"The patient does not seem to be hiding the truth: she really believes what she says."},{"idx":1,"correct":true,"proposition":"Impaired judgment","justification":""},{"idx":2,"correct":false,"proposition":"Cenesthetic hallucinations","justification":""},{"idx":3,"correct":true,"proposition":"Delusions of persecution","justification":""},{"idx":4,"correct":false,"proposition":"Borderline personality traits","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-18-qi-4","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"The general practitioner having refused to prescribe a new scanner, Mrs. B decides to consult the same day at the emergency reception service (SAU) closest to her home. She refuses the nurse to take vital constants and threatens to commit suicide << like my father >> she says, if she is not examined by a neurosurgeon. When she is told that there is no neurosurgeon in the facility, Mrs. B gets up and walks to the exit without a word. Which of the following indicates a high suicidal risk in Mrs. B.?","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"The presence of suicidal threats","justification":""},{"idx":1,"correct":true,"proposition":"The absence of relatives at his side","justification":""},{"idx":2,"correct":true,"proposition":"The presence of delusions","justification":""},{"idx":3,"correct":false,"proposition":"Taking estrogen-progestogens","justification":""},{"idx":4,"correct":true,"proposition":"His father's suicide","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-18-qi-5","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"The reception and orientation nurse tries to restrain Mrs. B but she threatens her with a pair of scissors that she has taken out of her bag. Which of the following is correct about physical restraint? ","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"It is justified by the immediate self-aggressive risk","justification":""},{"idx":1,"correct":true,"proposition":"It is justified by the immediate hetero-aggressive risk","justification":""},{"idx":2,"correct":false,"proposition":"It must be prescribed by a psychiatrist","justification":""},{"idx":3,"correct":false,"proposition":"She requires an admission measure in psychiatric care under duress","justification":""},{"idx":4,"correct":false,"proposition":"It must be declared secondarily to the liberty and detention judge","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-18-qi-6","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"Faced with self-threatening and hetero-aggressive threats, it is decided to resort to physical restraint. As the patient refuses any oral sedative treatment, an intramuscular injection of a sedative antipsychotic is prescribed. Which of the following considerations led to a preference for the class of antipsychotics over that of benzodiazepines in this case?","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Electrocardiogram not performed","justification":""},{"idx":1,"correct":true,"proposition":"Better intramuscular absorption","justification":""},{"idx":2,"correct":false,"proposition":"Better respiratory tolerance","justification":"It is true that they do not have respiratory adverse effects but this is not at all a consideration to take into account since the patient has no respiratory history."},{"idx":3,"correct":false,"proposition":"Young age","justification":""},{"idx":4,"correct":false,"proposition":"Lower risk of dependence","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-18-qi-7","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"Once Mrs. B is sedated, the physical restraint is lifted. The inventory of his belongings does not show any other dangerous object and makes it possible to find the report of the scanner. Upon awakening, psychiatric advice is sought. Mrs. B again exposes her conviction of having been deceived by the radiology office in front of the absence of metallic foreign body. She explains that << they are in cahoots with the intermeditators who point my thoughts... but I'm not going to obey them even if they mess me up... I'm not going to kill my mother... unless she's in them...I mean my mother is me actually... >>. We note in the words of Mrs. B.:","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Hermetic speech","justification":"Incomprehensible and several degrees above"},{"idx":1,"correct":true,"proposition":"Neologism","justification":"Intermediator"},{"idx":2,"correct":true,"proposition":"Paralogism","justification":""},{"idx":3,"correct":false,"proposition":"Dreamlike","justification":""},{"idx":4,"correct":true,"proposition":"Hallucinations","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-18-qi-8","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"Which of the following mental disorders could explain the entire clinical picture?","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Depressive episode with psychotic features","justification":"No symptoms of depression"},{"idx":1,"correct":true,"proposition":"Schizophrenia","justification":""},{"idx":2,"correct":false,"proposition":"Persistent delusional disorder","justification":""},{"idx":3,"correct":true,"proposition":"Encephalitis","justification":""},{"idx":4,"correct":false,"proposition":"Dissociative disorders","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-18-qi-9","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"The patient agrees to provide contact information for her mother who goes to the emergency room. She is received alone and then with her daughter who is told of the need for psychiatric hospitalization in another institution. The patient is reluctant to hospitalize in psychiatry but would accept to be hospitalized for << extraction of intermeditation electrodes >>. What orientation(s) do you recommend?","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Admission to voluntary psychiatric care","justification":""},{"idx":1,"correct":true,"proposition":"Admission to Conventional Third Party Psychiatric Care (PTDC)","justification":""},{"idx":2,"correct":false,"proposition":"Admission to Psychiatric Care at the Request of a Third Party in Emergency (UTDPS)","justification":""},{"idx":3,"correct":false,"proposition":"Admission to psychiatric care for imminent peril (SPPI)","justification":""},{"idx":4,"correct":false,"proposition":"Admission to psychiatric care by decision of the representative of the state (SPDRE)","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-18-qi-10","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"The anamnesis is completed in the psychiatric ward where Mrs. B was hospitalized at the request of a third party. Mrs. B, who lives with her mother, has been complaining of trouble concentrating and paying attention for more than a year and has sometimes been soliloquizing for at least six months. She no longer goes out and has gradually abandoned her usual activities, especially social ones. Unemployed after the non-renewal of a COD, she has not taken any steps to find work. The diagnosis of schizophrenia is made and pharmacological treatment is indicated. Which of the following should be part of the pre-therapeutic assessment:","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Blood pressure measurement","justification":""},{"idx":1,"correct":true,"proposition":"Blood glucose measurement","justification":""},{"idx":2,"correct":true,"proposition":"Lipid profile","justification":""},{"idx":3,"correct":false,"proposition":"Proteinuria","justification":""},{"idx":4,"correct":false,"proposition":"Electroencephalogram","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-18-qi-11","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"The pre-therapeutic assessment performed shows no abnormality and Mrs. B is not pregnant. Treatment with oral risperidone is started. After 4 weeks of treatment, neurological examination now shows a marked tremor of the extremities and a bilateral and symmetrical cogwheel. Mrs. B is less vehement but remains determined to obtain the surgical extraction of the device that she believes would have been implanted to manipulate it. Which of the following hypotheses could explain the persistence of positive symptoms? ","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Absence of associated psychotherapy","justification":"This cannot be a cause of persistence of hallucinations."},{"idx":1,"correct":false,"proposition":"Lack of actual treatment","justification":"The patient is hospitalized and the actual intake of treatments is monitored."},{"idx":2,"correct":true,"proposition":"Hidden cannabis intake","justification":""},{"idx":3,"correct":true,"proposition":"Comorbid neurological disorder","justification":""},{"idx":4,"correct":false,"proposition":"Partial dopaminergic agonist properties of the molecule","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-18-qi-12","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"The same treatment is continued for 4 more weeks. Mrs. B continues to report a manipulation of her thoughts but no longer plans to resort to surgery and recognizes that the treatment does her good. The discourse and thought remain disorganized but the first home leaves went well and a release is envisaged. Faced with the persistence of cognitive complaints about attention and concentration, a neuropsychological assessment is carried out which shows a marked alteration of executive functions. To what can you attribute this objective alteration? ","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Schizophrenic disorder","justification":""},{"idx":1,"correct":true,"proposition":"To an unknown addictive comorbidity","justification":""},{"idx":2,"correct":false,"proposition":"Iatrogenic hyperprolactinemia","justification":""},{"idx":3,"correct":false,"proposition":"The stress of hospitalization","justification":""},{"idx":4,"correct":false,"proposition":"Extrapyramidal syndrome","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-18-qi-13","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"Given the persistence of hallucina1ions and disorganization after several months of treatment, it was decided to replace risperidone with another atypical antipsychotic. After 3 months of treatment with olazanpine at optimal dosage, Mrs. B's disorders remain very disabling. You decide to change the antipsychotic treatment again. Which of the following options should be considered first? ","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":false,"proposition":"Replacement with aripiprazole","justification":""},{"idx":1,"correct":true,"proposition":"Replacement with clozapine","justification":""},{"idx":2,"correct":false,"proposition":"Replacement with a typical antipsychotic","justification":""},{"idx":3,"correct":false,"proposition":"Potentiation by the addition of a typical antipsychotic","justification":""},{"idx":4,"correct":false,"proposition":"Potentiation by the addition of a thymoregulator","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-18-qi-14","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"Which of the following is an advantage(s) of clozapine therapy in this patient ","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Superior efficacy to other antipsychotics in treatment resistance","justification":""},{"idx":1,"correct":false,"proposition":"Lower risk of inducing metabolic syndrome","justification":"The risk is increased"},{"idx":2,"correct":true,"proposition":"Lower risk of extrapyramidal side effects","justification":""},{"idx":3,"correct":true,"proposition":"Reducing the risk of suicide","justification":""},{"idx":4,"correct":false,"proposition":"Possibility of resorting to a delayed form in case of poor compliance","justification":""}],"type":"dp"}
+{"_id":"annales-2018-dp-18-qi-15","context":"Mrs. B consults general medicine to ask for a brain scan. This 27-year-old woman spontaneously reports only difficulties of concentration and attention of progressive onset for a few months but says she is certain that this examination will not be normal. The neurological examination is unremarkable. She does not take any treatment other than estrogen-progestin contraception. ","enonce":"The symptomatology improves markedly with clozapine until Mrs. B considers working again. Which of the following measures can (which) specifically promote this project?","item":"annales-2018-dp-18","matiere":"annales-2018","propositions":[{"idx":0,"correct":true,"proposition":"Cognitive remediation","justification":""},{"idx":1,"correct":true,"proposition":"Application for recognition of the status of disabled worker","justification":""},{"idx":2,"correct":false,"proposition":"Application for guardianship","justification":""},{"idx":3,"correct":true,"proposition":"Use of an Establishment and Work Assistance Service","justification":""},{"idx":4,"correct":false,"proposition":"Search for a home of life","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-1-qi-1","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"Among the risks associated with this trip, what are the 2 potentially most serious? ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Turista (traveller's diarrhea)","justification":""},{"idx":1,"correct":true,"proposition":"Traffic accidents","justification":"Accidents in the broad sense are the leading cause of death when travelling abroad"},{"idx":2,"correct":false,"proposition":"Dengue fever","justification":""},{"idx":3,"correct":false,"proposition":"Rickettsiosis","justification":""},{"idx":4,"correct":true,"proposition":"Malaria","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-1-qi-2","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"What is (are) the possible preventive attitude(s) for this stay vis-à-vis the malaria risk? ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"No chemoprophylaxis","justification":""},{"idx":1,"correct":true,"proposition":"Atovaquone-proguanil chemoprophylaxis","justification":"Daily intake from the first day + one week after return"},{"idx":2,"correct":false,"proposition":"Mefloquine chemoprophylaxis","justification":"She has a psychiatric history, which contraindicates mefloquine"},{"idx":3,"correct":true,"proposition":"Doxycycline chemoprophylaxis","justification":""},{"idx":4,"correct":false,"proposition":"Chloroquine-proguanil chemoprophylaxis","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-1-qi-3","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"What information(s) do you give him about the yellow fever vaccine?","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Vaccine done in an approved center","justification":""},{"idx":1,"correct":true,"proposition":"Vaccine to be recorded on a WHO-approved international immunization record","justification":""},{"idx":2,"correct":false,"proposition":"Vaccine valid for 10 years","justification":""},{"idx":3,"correct":true,"proposition":"Live attenuated virus vaccine","justification":""},{"idx":4,"correct":false,"proposition":"Vaccine that should not be given on the same day as typhoid vaccine","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-1-qi-4","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"The patient travels to Côte d'Ivoire 🇨🇮 with antimalarial chemoprophylaxis with doxycycline. What should she remember as information about taking this medicine? (one or more answers are true) ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Daily intake","justification":""},{"idx":1,"correct":false,"proposition":"To start 1 month before departure","justification":"From the first day of departure"},{"idx":2,"correct":false,"proposition":"To be stopped on the day of return to France","justification":""},{"idx":3,"correct":true,"proposition":"To be stopped if pregnancy occurs","justification":""},{"idx":4,"correct":false,"proposition":"Must be combined with mefloquine due to prolonged stay","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-1-qi-5","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"Three months later, on the day of her return to France, the patient comes to your office because, for 2 days, she has not felt well and has pollakiuria with urination burns. During your discussion, she tells you that she had abdominal pain and diarrhea for a few days a little more than a month before her return that led her to stop doxycycline, thinking that this drug was the cause. Which of the following clinical signs is the most important to collect when deciding what to do? ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Number of urination per day","justification":""},{"idx":1,"correct":false,"proposition":"Blood in urine","justification":""},{"idx":2,"correct":false,"proposition":"Existence of urgency","justification":""},{"idx":3,"correct":false,"proposition":"Date of last urinary tract infection","justification":""},{"idx":4,"correct":true,"proposition":"Presence of fever","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-1-qi-6","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"The patient is not febrile and you are moving towards simple cystitis. The urine strip is positive. At this stage, what is the most relevant complementary examination? B. Search for ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"CRP","justification":""},{"idx":1,"correct":false,"proposition":"Chlamydia search","justification":""},{"idx":2,"correct":false,"proposition":"ECBU","justification":"Simple cystitis does not require ECBU (unlike cystitis at risk of complications)"},{"idx":3,"correct":true,"proposition":"No exam","justification":""},{"idx":4,"correct":false,"proposition":"NFS","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-1-qi-7","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"You do not carry out any additional examination. Which of the following treatment options will you choose as a first-line treatment for this patient? ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Fosfomycin-trometamol single dose","justification":""},{"idx":1,"correct":false,"proposition":"Ofloxacin single dose","justification":""},{"idx":2,"correct":false,"proposition":"Ciprofloxacin 5 days","justification":""},{"idx":3,"correct":false,"proposition":"Pivmecillinam 5 days","justification":""},{"idx":4,"correct":false,"proposition":"Nitrofurantoin 5 days","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-1-qi-8","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"What other recommendation(s) do you make? ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Do a follow-up ECBU in 72 hours (3 days)","justification":""},{"idx":1,"correct":true,"proposition":"Drink and urinate regularly","justification":""},{"idx":2,"correct":false,"proposition":"Take cranberry juice daily","justification":"This advice is relevant in case of recurrent cystitis (we are in the case of simple cystitis)"},{"idx":3,"correct":false,"proposition":"Do a vesicorenal ultrasound at a distance from the current episode","justification":""},{"idx":4,"correct":false,"proposition":"Abstaining from sex for 10 days","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-1-qi-9","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"Ten days later, the patient returns to your office with her partner. She tells you that the urinary signs disappeared 2 days after the treatment but that, for 4 days, she had several outbreaks of high fever with chills and sweats. She complains of stubborn headaches, nausea and abdominal pain with loose stools. The patient is apyretic, her clinical examination is normal, there is in particular no meningeal syndrome. Which of the following diagnoses should you mention first in this patient? ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Malaria","justification":""},{"idx":1,"correct":false,"proposition":"Acute pyelonephritis","justification":""},{"idx":2,"correct":false,"proposition":"Dengue fever","justification":""},{"idx":3,"correct":false,"proposition":"Typhoid fever","justification":""},{"idx":4,"correct":false,"proposition":"Chikungunya","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-1-qi-10","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"Which of the following clinical elements supports the diagnosis of malaria in this patient? ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"3 months stay in Ivory Coast","justification":""},{"idx":1,"correct":true,"proposition":"Digestive disorders","justification":""},{"idx":2,"correct":false,"proposition":"Cystitis preceding this febrile episode","justification":"There is no link between cystitis and malaria"},{"idx":3,"correct":true,"proposition":"Discontinuation of doxycycline 1 month before returning to France","justification":""},{"idx":4,"correct":true,"proposition":"Fever progressing in peaks","justification":"Periodic\/intermittent fever is common in malaria."}],"type":"dp"}
+{"_id":"annales-2019-dp-1-qi-11","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"You urgently carry out a check-up on this patient, the results of which are as follows. Which one(s) is the most suggestive of malaria diagnosis? ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Hemoglobin: 10.8 g\/dL","justification":""},{"idx":1,"correct":true,"proposition":"Blisters: 45 g\/L","justification":""},{"idx":2,"correct":false,"proposition":"CRP to 95","justification":""},{"idx":3,"correct":false,"proposition":"ALAT to 1.2","justification":""},{"idx":4,"correct":false,"proposition":"Kalemia at 3.3 mmol\/L","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-1-qi-12","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"Which exam(s) will allow you to make the diagnosis of malaria now? ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Blood","justification":""},{"idx":1,"correct":false,"proposition":"Malaria blood serology","justification":""},{"idx":2,"correct":true,"proposition":"Rapid test for HRP2 antigen","justification":""},{"idx":3,"correct":true,"proposition":"Blood smear","justification":""},{"idx":4,"correct":false,"proposition":"Procalcitonin","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-1-qi-13","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"The blood smear is 0.5% positive for Plasmodium falciparum. The patient does not vomit and wishes to go home. What first-line care do you offer her knowing that she is not pregnant? ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Quinine","justification":""},{"idx":1,"correct":false,"proposition":"Atovaquone + proguanil","justification":""},{"idx":2,"correct":true,"proposition":"Artenimol-piperaquine","justification":""},{"idx":3,"correct":true,"proposition":"Artemether-lumefantrine","justification":""},{"idx":4,"correct":false,"proposition":"Outpatient treatment","justification":"Her platelets are less than 50 G \/ L (question 11) so she has a hospitalization criterion. The statement is misleading because the patient's wish is always important and it is he who has the last word (we can not force this patient to be hospitalized), but the question is specifically about \"what we offer her\": we offer her hospitalization."}],"type":"dp"}
+{"_id":"annales-2019-dp-1-qi-14","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"You cannot treat this patient on an outpatient basis. Why (one or more possible answers)? ","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"CRP 95 mg\/L","justification":""},{"idx":1,"correct":false,"proposition":"0.5% parasitemia","justification":""},{"idx":2,"correct":true,"proposition":"45 G\/L blisters","justification":""},{"idx":3,"correct":false,"proposition":"Haemoglobin at 10.8 g\/dL","justification":""},{"idx":4,"correct":false,"proposition":"Treatment with artenimol-piperaquine","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-1-qi-15","context":"A 29-year-old woman from Ivory Coast consults you in your general practice because she plans to go to Ivory Coast for 3 months to visit her family. She has a notable history of several episodes of urinary tract infections and a depressive episode that required hospitalization the year she arrived in France. She has been in France for 10 years, lives as a couple, and works as a caregiver for the elderly. She has never returned to Ivory Coast since arriving in France and is worried about the risks to her health. It is up to date with diphtheria, tetanus, polio, pertussis, hepatitis B vaccines. ","enonce":"After 3 days of hospitalization, the patient is apyretic with a negative thick drip smear and can be discharged. At what time(s) do you organise biological controls?","item":"annales-2019-dp-1","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"On the 5th day of the start of treatment"},{"idx":1,"correct":true,"proposition":"On the 7th day of the start of treatment","justification":"J3, J7, J28 😊 . It fell twice, so that's to know."},{"idx":2,"correct":false,"proposition":"On day 14 of the start of treatment"},{"idx":3,"correct":false,"proposition":"On the 21st day of the start of treatment"},{"idx":4,"correct":true,"proposition":"On the 28th day of the start of treatment"}],"type":"dp"}
+{"_id":"annales-2019-dp-3-qi-1","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"Which clinical sign(s) would direct you to Pancoast-Tobias syndrome? Give the correct answer(s).","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"An alteration of the general condition","justification":""},{"idx":1,"correct":true,"proposition":"A deficit of the interosseous muscles of the hand","justification":"There are 4 palmar interosseous and 4 dorsal interosseous. They are innervated by the C8 Th1 ulnar nerve, which is affected in Pancoast-Tobias syndrome."},{"idx":2,"correct":false,"proposition":"Diplopia","justification":"It is a symptom found in alternating syndromes for example"},{"idx":3,"correct":false,"proposition":"Irradiation of pain in the thumb","justification":"The ulnar nerve innervates the fifth finger and medial half of the fourth."},{"idx":4,"correct":true,"proposition":"The association a ptosis","justification":"Ptosis - Myosis - Enophtalmos is part of another syndrome 😉"}],"type":"dp"}
+{"_id":"annales-2019-dp-3-qi-2","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"The patient does not have an impairment in the general condition. Which of the following signs is the one that points to a joint cause of pain? Give the correct answer(s).","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Limiting passive lateral rotation","justification":""},{"idx":1,"correct":false,"proposition":"Localization of pain on the anterior side of the shoulder","justification":""},{"idx":2,"correct":false,"proposition":"Worsening pain in abduction","justification":""},{"idx":3,"correct":true,"proposition":"Presence of joint effusion","justification":"Joint effusion is often a sign of a local inflammatory cause"},{"idx":4,"correct":false,"proposition":"Pain on palpation of the delto-pectoral sulcus","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-3-qi-3","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"Which of these muscles is (are) part of the rotator cuff? Give the correct answer(s).","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"The supraspinatus tendon","justification":""},{"idx":1,"correct":false,"proposition":"The large round tendon","justification":"The little circle is one of them. Unfortunately, you have to learn these muscles - this question often falls, whether in IQ or PD."},{"idx":2,"correct":false,"proposition":"The tendon of the deltoid","justification":""},{"idx":3,"correct":true,"proposition":"Subscapularis tendon","justification":""},{"idx":4,"correct":true,"proposition":"The infraspinatus tendon ","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-3-qi-4","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"The clinical examination reveals an active abduction of normal but painful amplitude of the shoulder. There is a painful arc with active abduction pain between 60 ° and 120 °. The lateral rotation is of normal and symmetrical amplitude. The passive elevation of the upper limb in internal rotation and antepulsion is painful. The following clinical maneuver is painful while other cuff muscle tensioning maneuvers are painless. Which tendon is responsible?","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"The supraspinatus tendon","justification":"This is Jobe's maneuver"},{"idx":1,"correct":false,"proposition":"The large round tendon","justification":""},{"idx":2,"correct":false,"proposition":"The tendon of the deltoid","justification":""},{"idx":3,"correct":false,"proposition":"Subscapularis tendon","justification":""},{"idx":4,"correct":false,"proposition":"The infraspinatus tendon ","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-3-qi-5","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"You do a standard X-ray to the patient (below). Which of these proposals is the exact answer(s)? Give the correct answer(s).","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"There is a decrease in the height of the space under acromial","justification":""},{"idx":1,"correct":false,"proposition":"There is osteoarthritis","justification":""},{"idx":2,"correct":false,"proposition":"There is calcification of the rotator cuff tendons","justification":""},{"idx":3,"correct":true,"proposition":"X-ray is normal","justification":""},{"idx":4,"correct":false,"proposition":"There is osteolysis of the major tubercle","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-3-qi-6","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"At this stage of management, which additional imaging test(s) of the right shoulder can you request? Give the correct answer(s).","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Scanner","justification":""},{"idx":1,"correct":true,"proposition":"MRI","justification":"MRI and ultrasound are the two tests that directly visualize the tendons."},{"idx":2,"correct":false,"proposition":"Arthro-MRI","justification":""},{"idx":3,"correct":false,"proposition":"Arthroscanner","justification":""},{"idx":4,"correct":true,"proposition":"Echography","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-3-qi-7","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"The sonographer answers that it is an unruptured tendinopathy of the supraspinatus. You prescribe shoulder rehabilitation. In this patient, what is(are) the objective(s) of physiotherapy? Give the correct answer(s).","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Strengthen the deltoid","justification":""},{"idx":1,"correct":true,"proposition":"Strengthen the latissimus dorsi","justification":""},{"idx":2,"correct":false,"proposition":"Increase passive range of motion","justification":"The question insists on 'this patient' who does not have passive range of motion."},{"idx":3,"correct":true,"proposition":"Reduce pain","justification":""},{"idx":4,"correct":true,"proposition":"Provide educational advice","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-3-qi-8","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"After a month and 15 sessions of physiotherapy, the patient is still as painful when raising the shoulder. Which strategy(s) is relevant? Give the correct answer(s).","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"You check if the patient is observant","justification":""},{"idx":1,"correct":true,"proposition":"You check the tolerance of the sessions","justification":""},{"idx":2,"correct":true,"proposition":"You strengthen analgesic care","justification":""},{"idx":3,"correct":false,"proposition":"You request a shoulder scan","justification":"The CT scan is not very useful for the study of tendons, MRI is preferred."},{"idx":4,"correct":true,"proposition":"You check your differential diagnoses","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-3-qi-9","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"The patient was able to return to work. Trying to catch up with a slide on a scaffolding, he has complete functional impotence of the right upper limb. Here is the front X-ray of the right shoulder. What element(s) does it bring you? Give the correct answer(s).","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"There is a fracture of the surgical cervix of the humerus","justification":""},{"idx":1,"correct":true,"proposition":"There is an anteroinferior glenohumeral dislocation","justification":""},{"idx":2,"correct":false,"proposition":"There is an acromioclavicular disjunction","justification":""},{"idx":3,"correct":false,"proposition":"There is a fracture of a displaced rib","justification":""},{"idx":4,"correct":false,"proposition":"There is a notch of Malgaigne","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-3-qi-10","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"Before proceeding to reduce this dislocation, you examine the sensitivity of the stump of the shoulder. An isolated abnormality at this level is in favor of nerve damage: ","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"axillary","justification":""},{"idx":1,"correct":false,"proposition":"supraspinatus","justification":""},{"idx":2,"correct":false,"proposition":"long thoracic","justification":""},{"idx":3,"correct":false,"proposition":"radial","justification":""},{"idx":4,"correct":false,"proposition":"musculocutaneous","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-3-qi-11","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"The patient did not have associated nerve damage prior to external manoeuvring reduction of the glenohumeral joint. The review of awareness after reduction is not changed. You set up an immobiliatlon by an elbow brace to the body. You see the patient again a month later. On clinical examination, you notice the following: passive mobility is not diminished, the right arm in anterior elevation and internal rotation, the patient can not resist the force of abbaissement that you exert, when he wants to bring his hand to the mouth, you observe that the patient is forced to raise his elbow laterally above the level of his hand. In addition, the arm placed in external rotation elbows to the body, there is an automatic internal rotation. Passive external rotation is not increased. The patient retains the possibility of taking off the hand placed in the back at the lumbosacral junction. There is no abnormality during thwarted active flexion of the elbow when the palms are up. Given the data of the clinical examination, you mention the possibility of a rupture of one or more of the following elements: (one or more true propositions)","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Supraspinatus","justification":""},{"idx":1,"correct":false,"proposition":"Pectoralis Major","justification":""},{"idx":2,"correct":true,"proposition":"Infraspinatus","justification":""},{"idx":3,"correct":true,"proposition":"Teres minor (small round)","justification":""},{"idx":4,"correct":false,"proposition":"Subscapular","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-3-qi-12","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"Given the functional discomfort, rotator cuff repair surgery is offered to the patient. While waiting for the consultation of the anaesthetist, the patient asks you a few questions. Which of the following answers you could give is correct? ","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"For this scheduled procedure, the anesthesia consultation can take place until the day before the intervention","justification":""},{"idx":1,"correct":false,"proposition":"You will see either a doctor or a nurse anaesthetist for this consultation","justification":""},{"idx":2,"correct":true,"proposition":"You will not necessarily have to take a blood test before the procedure","justification":""},{"idx":3,"correct":true,"proposition":"If you do not wish to have locoregional anesthesia, you can refuse it","justification":"It is always the patient who decides!"},{"idx":4,"correct":false,"proposition":"As you are taking aspirin for the heart, it will in any case be necessary to stop it between 5 and 7 days before the procedure","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-3-qi-13","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"The patient is now in the post-interventional monitoring room following his surgery, which took place without incident anesthetic and surgically. He expresses pain at 8 out of 10 on the numerical scale and asks to be relieved. Which multimodal analgesia(s) are indicated in this context, among the analgesia represented in the figure below? PCA: patient-controlled analgesia (or PDA) ","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Has","justification":""},{"idx":1,"correct":false,"proposition":"B","justification":""},{"idx":0,"correct":false,"proposition":"C","justification":""},{"idx":1,"correct":false,"proposition":"D","justification":""},{"idx":0,"correct":true,"proposition":"E","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-3-qi-14","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"Morphine titration was initiated because it was severe pain. It was relayed by patient-controlled analgesia (PCA) with paracetamol and nefopam as part of multimodal postoperative analgesia. It has been effective. The ACP was arrested on the second day. On the third day, the patient again complains of pain, the intensity of which is measured at 54 mm on a visual analogue scale, and he wishes to be relieved. His current analgesic treatment includes paracetamol and nefopam. Which treatment(s) is (are) indicated in the context of multimodal analgesia in this context? ","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Tramadol","justification":""},{"idx":1,"correct":false,"proposition":"Ketoprofen (NSAIDs)","justification":""},{"idx":2,"correct":false,"proposition":"Oxycodone","justification":""},{"idx":3,"correct":false,"proposition":"Transcutaneous electrical nerve stimulation (TENS)","justification":""},{"idx":4,"correct":true,"proposition":"Application of refrigeration","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-3-qi-15","context":"A 50-year-old mason consults for pain in the right shoulder evolving for 6 months. He is an unweaned 40 PA smoker and a carrier of ischemic heart disease on antiplatelet agents. There is irradiation in the right upper limb poorly systematized.","enonce":"After 5 months of rehabilitation, the patient has regained satisfactory active and passive mobility and he hardly complains of pain. He questions you about the resumption of his work because he fears that he will not be able to continue his activity. In agreement with your patient, you wish to contact his occupational physician. Which element(s) is (are) relevant to transmit to the occupational physician? ","item":"annales-2019-dp-3","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"None, so as not to break medical confidentiality","justification":""},{"idx":1,"correct":true,"proposition":"Functional sequelae on the shoulder","justification":""},{"idx":2,"correct":true,"proposition":"The initial lesion assessment","justification":""},{"idx":3,"correct":false,"proposition":"A certificate of aptitude for his position","justification":""},{"idx":4,"correct":true,"proposition":"Possible extra-occupational risk factors","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-5-qi-1","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"Which of the following clinical elements is present in the observation?","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Spatial disorientation","justification":"'She thinks she is at home'"},{"idx":1,"correct":true,"proposition":"Zoopsies","justification":"'Scaring away cockroaches' 🐾"},{"idx":2,"correct":true,"proposition":"Disturbance of attention","justification":"'You have to repeat it several times because it seems elsewhere'"},{"idx":3,"correct":false,"proposition":"Tachypsychia","justification":""},{"idx":4,"correct":false,"proposition":"Mental automatism","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-5-qi-2","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"Faced with this state of agitation, which of the following elements present in the observation, which one (directs) towards a delirium rather than an acute psychotic state?","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Spatial disorientation","justification":""},{"idx":1,"correct":false,"proposition":"Delusions of persecution","justification":"These are characteristic of the LFS"},{"idx":2,"correct":true,"proposition":"Abrupt onset in a post-operative context","justification":"The postoperative context points much more towards confusion (known link between confusion and surgery) than towards EPA (no known link between EPA and surgery)"},{"idx":3,"correct":false,"proposition":"Major anxiety","justification":"Anxiety is found in both etiologies. This is a characteristic of agitation."},{"idx":4,"correct":true,"proposition":"Fluctuation of symptoms","justification":"The EPA does not fluctuate, or does not fluctuate, or little"}],"type":"dp"}
+{"_id":"annales-2019-dp-5-qi-3","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"Which of the following clinical elements would be in favor of delirium syndrome?","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Time disorientation","justification":"This is characteristic"},{"idx":1,"correct":true,"proposition":"Hyperthermia","justification":"This can be a confusing trigger"},{"idx":2,"correct":true,"proposition":"Predominance of visual hallucinations","justification":"Visual (rather than auditory) hallucinations are often found in confusion."},{"idx":3,"correct":false,"proposition":"Psychiatric history","justification":""},{"idx":4,"correct":true,"proposition":"Reversal of the nycthemeral rhythm","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-5-qi-4","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"The agitation is fluctuating but she does not repeat her hetero-aggressive threats and agrees to be escorted back to her room. She remains disoriented in space and time. At this stage, which of the following additional examinations is essential to carry out immediately? ","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Alcohol","justification":""},{"idx":1,"correct":false,"proposition":"Search for urinary toxicants","justification":""},{"idx":2,"correct":true,"proposition":"Capillary blood glucose","justification":"Any acute and non-systematized neurological signs should be investigated for hypoglycemia as a first-line treatment."},{"idx":3,"correct":false,"proposition":"Injected brain scan","justification":""},{"idx":4,"correct":false,"proposition":"Blood ionogram","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-5-qi-5","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"Capillary blood glucose is 3.8 mmol\/L. Which of the following causes should be mentioned in front of the clinical picture presented by the patient? ","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Alcohol withdrawal","justification":""},{"idx":1,"correct":true,"proposition":"Adverse effects of opioid analgesics","justification":""},{"idx":2,"correct":false,"proposition":"Hypoglycaemia","justification":"Blood sugar is normal"},{"idx":3,"correct":true,"proposition":"Subacute subdural hematoma","justification":""},{"idx":4,"correct":true,"proposition":"Hyponatremia","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-5-qi-6","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"Physical examination shows sweating, tachycardia and tremor of extremities. The neurological examination cannot be continued due to increased agitation. The patient nevertheless accepts oral treatment. What do you recommend? ","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Benzodiazepine therapy","justification":"We start on an alcoholic withdrawal in view of the clinical description and the context of the patient."},{"idx":1,"correct":false,"proposition":"Treatment with sedative neuroleptic","justification":""},{"idx":2,"correct":true,"proposition":"Brain scan without injection as soon as possible","justification":""},{"idx":3,"correct":true,"proposition":"Constant behavioural monitoring","justification":""},{"idx":4,"correct":false,"proposition":"Request for psychiatric opinion","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-5-qi-7","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"Given the delirium syndrome and the context of fall with scalp wound, a brain scan is prescribed urgently after benzodiazepine sedation. The brain scan is normal but biology shows a moderate elevation of gamma-glutamyl-transpeptidase (GGT) and transaminases (predominant on AST) contrasting with a normal level of alkaline phosphatase, as well as an elevation of mean corpuscular volume. The blood ionogram and serum calcium are normal. CPKs are quietly increased. The temperature is 37.8 °C.  The patient is no longer agitated but still disoriented, anxious and continues to make delusional remarks. What do you recommend in the immediate future? (one or more responses) ","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Thiamine","justification":""},{"idx":1,"correct":true,"proposition":"Hydration","justification":""},{"idx":2,"correct":false,"proposition":"Valproic acid","justification":""},{"idx":3,"correct":false,"proposition":"Physical restraint","justification":"The patient is no longer agitated"},{"idx":4,"correct":false,"proposition":"Antipsychotic","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-5-qi-8","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"You have set up intravenous hydration treatment and administration of vitamin B1 and Diazepam. Which of the following clinical and biological elements is part of the monitoring of delirium tremens?","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Blood pressure"},{"idx":1,"correct":true,"proposition":"Heart rate"},{"idx":2,"correct":true,"proposition":"Temperature","justification":"The patient is subfebrile. The normalization of its temperature is monitored. This parameter is not part of the Cushman score (but it is still checked in the delirium tremens) 😉"},{"idx":3,"correct":false,"proposition":"Haemoglobin"},{"idx":4,"correct":false,"proposition":"Gamma-glutamyl-transpeptidase","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-5-qi-9","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"The evolution of delirium is favorable in a few days and an addictological consultation is organized. The patient reports excessive daily alcohol consumption but says she has not lost control of her consumption and does not need addiction management. Which of the following attitudes you could adopt to promote patient adherence, which are specifically motivational interviewing techniques? ","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Explain the link between alcohol consumption and delirium tremens episode","justification":""},{"idx":1,"correct":false,"proposition":"Explain other risks associated with alcohol consumption","justification":""},{"idx":2,"correct":true,"proposition":"Ask the patient what her alcohol consumption brings","justification":""},{"idx":3,"correct":true,"proposition":"Talk about ambivalence to change as normal","justification":""},{"idx":4,"correct":false,"proposition":"Introduce drug treatments to help maintain abstinence","justification":"Motivational interviewing meets a very specific definition."}],"type":"dp"}
+{"_id":"annales-2019-dp-5-qi-10","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"The patient is followed by her general practitioner with a goal of complete abstinence. However, she was unable to stop drinking for more than five days. Which of the following classes of drugs can be prescribed as an aid to maintain abstinence? ","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"A selective serotonin reuptake inhibitor","justification":""},{"idx":1,"correct":false,"proposition":"A benzodiazepine","justification":""},{"idx":2,"correct":true,"proposition":"An opioid antagonist","justification":""},{"idx":3,"correct":false,"proposition":"A thymoregulator","justification":""},{"idx":4,"correct":false,"proposition":"An anticonvulsant","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-5-qi-11","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"Management by the general practitioner continues, but without a significant reduction in alcohol consumption. She continues to drink one and a half bottles of wine a day. The patient often comes to the consultations having been drinking. She then cries a lot, says she is sad, lacking appetite and blaming herself. What therapeutic strategy(s) is (are) indicated for this patient? ","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":" Outpatient care in an addiction center","justification":""},{"idx":1,"correct":false,"proposition":"Emergency psychiatric hospitalization","justification":""},{"idx":2,"correct":false,"proposition":"Prescribing an antidepressant","justification":"The description does not meet the DSM-5 criteria for depression."},{"idx":3,"correct":true,"proposition":"Cognitive Behavioural Therapy","justification":""},{"idx":4,"correct":true,"proposition":"Scheduled hospitalization for alcohol withdrawal","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-5-qi-12","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"The patient is cared for in a CSAPA (center for care, support and prevention in addiction) and a scheduled withdrawal has made it possible to obtain complete abstinence from alcohol for 3 months. Despite this, she continues to suffer from a deep malaise and tells her doctor that she can no longer bear to live alone, that she feels tired in the morning and needs several hours to prepare. It is very difficult to make decisions, she is incompetent in all areas and has a strong tendency to eat between meals to the point of having gained 5 kilos for 2 months. In addition, she worries almost all day and excessively for various reasons and takes more than an hour before falling asleep. She goes out little and sees very few people because she dreads all the encounters and is afraid of not being up to it. What diagnostic criterion(s) of severe depression do you identify among the symptoms presented by this patient:","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Self-depreciation","justification":"Minor criterion"},{"idx":1,"correct":false,"proposition":"Feeling lonely","justification":"Feeling lonely is not a DSM-5 criterion. Wicked trap 🙈"},{"idx":2,"correct":true,"proposition":"Cognitive impairment","justification":"Minor criterion"},{"idx":3,"correct":true,"proposition":"Overeating","justification":"Minor criterion"},{"idx":4,"correct":true,"proposition":"Slowdown","justification":"Minor criterion"}],"type":"dp"}
+{"_id":"annales-2019-dp-5-qi-13","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"What other diagnosis(s) does the patient's clinical picture suggest? ","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Generalized anxiety disorder (GAD)","justification":""},{"idx":1,"correct":true,"proposition":"Social phobia","justification":""},{"idx":2,"correct":false,"proposition":"Agoraphobia","justification":""},{"idx":3,"correct":false,"proposition":"Syndrome de Korsakoff","justification":""},{"idx":4,"correct":false,"proposition":"Schizoid personality disorder","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-5-qi-14","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"A prescription of antidepressant monotherapy (escitalopram) was implemented 4 months ago and has achieved complete remission of the depressive episode for 3 months now. The patient remained abstinent in alcohol 🍷. However, she remains very anxious in many situations of everyday life. What therapeutic orientation(s) is (are) indicated at this stage?","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Gradual discontinuation of escitalopram","justification":""},{"idx":1,"correct":true,"proposition":"Cognitive Behavioural Therapy","justification":""},{"idx":2,"correct":false,"proposition":"EMDR","justification":""},{"idx":3,"correct":false,"proposition":"Beta-blocker","justification":""},{"idx":4,"correct":false,"proposition":"Sedating neuroleptic","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-5-qi-15","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"After 12 months of treatment with escitalopram and maintenance of a complete and stable remission of the depressive episode, what argument(s) can justify the extension of this long-term treatment? ","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Identification of a history of depressive episodes","justification":""},{"idx":1,"correct":false,"proposition":"Identification of a history of manic episode","justification":""},{"idx":2,"correct":false,"proposition":"Signs of drug withdrawal occurring when you forget to take","justification":"There is no withdrawal syndrome"},{"idx":3,"correct":true,"proposition":"Severe generalized anxiety disorder","justification":""},{"idx":4,"correct":false,"proposition":"Avoidant personality disorder","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-5-qi-16","context":"A 54-year-old woman is hospitalized orthopedically following a fall at home that resulted in a scalp wound and an uncomplicated extra-articular fracture of the lower end of the radius that required reduction under general anesthesia and percutaneous embroidery surgical treatment. The following night, when a discharge is scheduled for the next day, the patient must be escorted back to her room several times by the health care team to whom she makes increasingly disjointed remarks. She thinks she is at home, walks through the ward and then tries to lock herself in the caregivers' rest room. When we talk to her, we have to repeat the questions several times because she seems elsewhere. She ends up talking about cameras in her room. She only agrees to return to it if the light is left on to, she says, \"scare away cockroaches\". Just when she seemed to have calmed down, she burst into the care station again, brandishing a fork that she pointed at the night shift and said she was not going to \"let it happen\".","enonce":"The patient consults a year later. She has not taken an antidepressant for 6 months, but takes alprazolam in varying doses prescribed by another doctor every day. What therapeutic strategy(s) can be proposed to limit the risk of benzodiazepine dependence in this patient? ","item":"annales-2019-dp-5","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Information on the risks of chronic benzodiazepine use","justification":""},{"idx":1,"correct":true,"proposition":"Participation in a mutual aid group (GEM)","justification":"Doubt on this question: there is no mention of these GEM in the college 🤷 ♂️ But we decide to tick it just since it seems logical."},{"idx":2,"correct":false,"proposition":"Extension of the prescription of alprazolam at a stable dose to achieve complete remission","justification":""},{"idx":3,"correct":false,"proposition":"Replacement of alprazolam with a benzodiazepine with a shorter half-life","justification":"The shorter the half-life, the higher the risk."},{"idx":4,"correct":true,"proposition":"Information on non-drug therapeutic alternatives","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-6-qi-1","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"Regarding the confusion in this situation, what is(are) the exact answer(s)? (one or more true propositions)","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"It can persist for several days","justification":"This is called post-critical confusion, which lasts a few minutes to a few hours."},{"idx":1,"correct":false,"proposition":"It may be followed by persistent cognitive impairment","justification":""},{"idx":2,"correct":true,"proposition":"It is manifested by a spontaneous language disorder","justification":""},{"idx":3,"correct":true,"proposition":"Its association with temporospatial disorientation is constant","justification":""},{"idx":4,"correct":true,"proposition":"It is manifested in particular by behavioral disorders","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-6-qi-2","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"Regarding the mechanism of this loss of knowledge, what is (are) the right proposal(s)? (one or more true propositions)","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"You mention the diagnosis of tonic-clonic seizure because witnesses report convulsive movements"},{"idx":1,"correct":false,"proposition":"You retain the diagnosis of tonic-clonic seizure since the patient reported a loss of urine","justification":""},{"idx":2,"correct":false,"proposition":"The absence of tongue bite makes it possible to rule out the diagnosis of tonic-clonic seizure","justification":""},{"idx":3,"correct":false,"proposition":"The fact that the patient says she does not remember anything supports a psychogenic origin of the loss of consciousness","justification":""},{"idx":4,"correct":true,"proposition":"The existence of confusion during the management by the SAMU makes you evoke a tonic-clonic epileptic seizure","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-6-qi-3","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"What element(s) would be in favor of convulsive syncope? ","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Extreme pallor","justification":""},{"idx":1,"correct":true,"proposition":"Immediate resumption of normal consciousness","justification":""},{"idx":2,"correct":false,"proposition":"Duration of loss of consciousness of at least five minutes","justification":"Rather epilepsy"},{"idx":3,"correct":false,"proposition":"Clonic shaking of all four limbs","justification":"Not the four members 😉"},{"idx":4,"correct":false,"proposition":"Loss of urine","justification":"It is not discriminatory."}],"type":"dp"}
+{"_id":"annales-2019-dp-6-qi-4","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"During the interrogation, you learn that the patient is sometimes surprised in the morning by jolts of the upper limbs. She even suddenly dropped the cup of coffee she was holding as the movement was so abrupt. Regarding this symptom, you mention:  ","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Tetany","justification":""},{"idx":1,"correct":false,"proposition":"Tics","justification":""},{"idx":2,"correct":false,"proposition":"Physiological myoclonus","justification":""},{"idx":3,"correct":true,"proposition":"Epileptic myoclonus","justification":""},{"idx":4,"correct":false,"proposition":"Psychogenic manifestations","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-6-qi-5","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"You integrate this symptom into your syndromic reasoning. What is the exact proposal(s):","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"This symptom calls into question the diagnosis of an epileptic mechanism concerning the episode of loss of consciousness","justification":""},{"idx":1,"correct":false,"proposition":"This symptom associated with the clinical suspicion of tonic-clonic seizure is in favor of secondarily generalized partial epilepsy","justification":""},{"idx":2,"correct":true,"proposition":"This symptom associated with clinical suspicion of tonic-clonic seizure is in favor of idiopathic generalized epilepsy","justification":""},{"idx":3,"correct":false,"proposition":"This symptom requires psychiatric advice","justification":""},{"idx":4,"correct":true,"proposition":"This symptom should cause the interrogation to look for photosensitivity","justification":"Triggering at light exposure."}],"type":"dp"}
+{"_id":"annales-2019-dp-6-qi-6","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"You remember the existence of epileptic myoclonus. Regarding epileptic myoclonus, which is (are) the exact proposal(s)? ","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"They can be observed during generalized epilepsy","justification":""},{"idx":1,"correct":true,"proposition":"They can be observed during partial epilepsies","justification":""},{"idx":2,"correct":true,"proposition":"They are favored by lack of sleep","justification":""},{"idx":3,"correct":true,"proposition":"They are favored by intermittent light stimulation","justification":""},{"idx":4,"correct":false,"proposition":"They can occur in the absence of concomitant epileptic discharge on the electroencephalogram","justification":"It would be bad luck anyway 🤔"}],"type":"dp"}
+{"_id":"annales-2019-dp-6-qi-7","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"In the first hours of your care, which additional examination(s) for etiological purposes will you perform? ","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"A brain MRI","justification":"Not in the first hours but it is systematic in a second time."},{"idx":1,"correct":false,"proposition":"A lumbar puncture","justification":"The repetition of symptoms is not in favor of an infectious origin."},{"idx":2,"correct":true,"proposition":"An electroeneghalogram","justification":"We will look for a background 😉 activity"},{"idx":3,"correct":false,"proposition":"A search for toxicants in urine","justification":"The repetition of symptoms is not in favor."},{"idx":4,"correct":false,"proposition":"A brain angiography","justification":"We can consider a CT scan, but not a CT angiography (we do not think of ischemia in front of this table)."}],"type":"dp"}
+{"_id":"annales-2019-dp-6-qi-8","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"You have to perform an electroencephalogram one hour after admission. What characteristic(s) do you remember at the seventh second of the recording? ","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Generalized epileptic discharge"},{"idx":1,"correct":false,"proposition":"A physiological trace (normal rhythm)"},{"idx":2,"correct":false,"proposition":"Discharge characteristic of an absence"},{"idx":3,"correct":true,"proposition":"One landfill recorded on all leads (lines)"},{"idx":4,"correct":false,"proposition":"A discharge characteristic of a partial crisis"}],"type":"dp"}
+{"_id":"annales-2019-dp-6-qi-9","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"A brain MRI is performed remotely, what do you expect (indicate the exact proposal(s))? ","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"It will be normal in case of idiopathic generalized epilepsy","justification":""},{"idx":1,"correct":true,"proposition":"An MRI abnormality is not necessarily responsible for epilepsy","justification":""},{"idx":2,"correct":false,"proposition":"An MRI abnormality will prove that the patient's symptoms are epileptic","justification":""},{"idx":3,"correct":false,"proposition":"The absence of abnormalities on MRI will make it possible to reject the diagnosis of epilepsy in this patient","justification":""},{"idx":4,"correct":false,"proposition":"The presence of an abnormality on MRI will prove that epilepsy is of partial origin in this patient","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-6-qi-10","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"Brain MRI is normal. What is the diagnosis? ","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":" Rolandic paroxysmic epilepsy ","justification":""},{"idx":1,"correct":true,"proposition":"Benign juvenile myoclonic epilepsy","justification":""},{"idx":2,"correct":false,"proposition":" Temporal partial epilepsy","justification":""},{"idx":3,"correct":false,"proposition":" Cryptogenic epilepsy","justification":""},{"idx":4,"correct":false,"proposition":"Convulsive syncope","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-6-qi-11","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"You have retained the diagnosis of benign juvenile myoclonic epilepsy. You discuss with the patient the initiation of background antiepileptic therapy. What is the exact proposal(s)? ","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"There is no indication for background anti-epileptic treatment as she had only one generalized seizure","justification":""},{"idx":1,"correct":false,"proposition":"The benign nature of epilepsia justifies therapeutic abstention","justification":""},{"idx":2,"correct":true,"proposition":"The prescription of background anti-epileptic treatment must be accompanied by therapeutic education","justification":""},{"idx":3,"correct":false,"proposition":"Prescription of background antiepileptic therapy contraindicates oral contraception","justification":""},{"idx":4,"correct":true,"proposition":"The prescription must be maintained over the long term to prevent the recurrence of its pathology","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-6-qi-12","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"Treated for 18 months with lamotrigine, she has never reoffended. She wants to pass her driver's license. What is the exact answer(s) regarding driving? ","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Driving a public transit vehicle is definitely contraindicated","justification":""},{"idx":1,"correct":false,"proposition":"Driving a light vehicle is possible without restriction","justification":""},{"idx":2,"correct":true,"proposition":"The physician must inform the patient of the regulatory procedures","justification":""},{"idx":3,"correct":false,"proposition":"Driving will be possible with a certificate from the attending physician","justification":""},{"idx":4,"correct":false,"proposition":"Taking antiepileptic treatment prohibits driving","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-6-qi-13","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"She asks you about her contraception. What is the exact answer(s)? ","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Oral contraception is contraindicated","justification":""},{"idx":1,"correct":false,"proposition":"Lamotrigine is an enzyme inducer of estrogen-progestin contraceptives","justification":""},{"idx":2,"correct":false,"proposition":"You recommend stopping antiepileptic treatment","justification":""},{"idx":3,"correct":true,"proposition":"You authorize the contraception of his choice","justification":""},{"idx":4,"correct":false,"proposition":"You recommend a change in antiepileptic treatment","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-6-qi-14","context":"A 17-year-old woman is referred by the SAMU to the emergency reception service because she had lost consciousness on the public road an hour earlier. Bystanders noticed convulsive movements and called the UAS. He arrived fifteen minutes after the loss of consciousness and tells you that the patient was confused. It reports urine loss. When you examine it, it is perfectly conscious, well oriented in time and space. She doesn't remember anything and asks you why she was hospitalized. Your clinical examination is normal.","enonce":"Five years later, the patient expresses a desire for pregnancy and wishes to have information. What is the exact answer(s)? ","item":"annales-2019-dp-6","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Genetic counseling should be offered","justification":""},{"idx":1,"correct":false,"proposition":"The context of pregnancy makes you offer dual therapy","justification":""},{"idx":2,"correct":true,"proposition":"You set up folic acid supplementation","justification":""},{"idx":3,"correct":false,"proposition":"Close ultrasound monitoring will be necessary during the last trimester of pregnancy","justification":""},{"idx":4,"correct":false,"proposition":"Under treatment the risk of malformation is higher than that of the general population","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-7-qi-1","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"In the emergency room, the patient is taken care of. The clinical examination, supplemented by imaging, confirms a closed fracture of the right wrist requiring surgery. The wounds of the upper limbs are to be sutured. The caregiver washes his hands according to the following steps. Which of the following suggestions for standard hygiene precautions for performing sutures in emergency rooms is correct?","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Wearing a surgical mask for the operator is recommended","justification":""},{"idx":1,"correct":false,"proposition":"The friction of the hands in 6 steps with a hydro-alcoholic solution, before the treatment, is in accordance with the recommendations","justification":""},{"idx":2,"correct":false,"proposition":"The duration of hand rubbing should last at least one minute","justification":"30 seconds ⌛ (painful trap)"},{"idx":3,"correct":true,"proposition":"Wearing a pair of goggles is recommended","justification":""},{"idx":4,"correct":true,"proposition":"Gloves are required","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-7-qi-2","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"The wounds were sutured. You ask the patient about his vaccination status that he does not know. What modality(s) of prevention of the risk of infection do you implement?","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"You give him an injection of 250 IU of tetanus immunoglobulins in the emergency room","justification":""},{"idx":1,"correct":true,"proposition":"You give him an injection of a dose of vaccine containing tetanus valence in the emergency room","justification":""},{"idx":2,"correct":false,"proposition":"You start antibiotic therapy with amoxicillin and clavulanic acid for a period of 10 days","justification":""},{"idx":3,"correct":true,"proposition":"You are planning a tetanus vaccination booster for this patient","justification":""},{"idx":4,"correct":true,"proposition":"You are planning a new consultation for wound healing monitoring in a week 1 1","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-7-qi-3","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"You inform the patient of the need for surgery followed by hospitalization to treat their wrist fracture. The patient refuses surgery and hospitalization. Which of the following proposals regarding patient information and consent is accurate? ","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"The patient's low level of understanding of the French language exempts the physician from obtaining the patient's consent","justification":""},{"idx":1,"correct":true,"proposition":"The doctor must inform this patient of the expected benefits and possible risks of the surgical procedure","justification":""},{"idx":2,"correct":false,"proposition":"The status of illegal alien exempts the doctor from obtaining the patient's consent","justification":""},{"idx":3,"correct":true,"proposition":"The physician must ensure the patient's understanding by asking him to say what he has understood","justification":""},{"idx":4,"correct":true,"proposition":"The presence of the interpreter is recommended during the interview with the patient","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-7-qi-4","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"The exchange with the patient highlights that his refusal is mainly motivated by the cost of surgery and hospitalization. His hospitalization costs will be covered under which device?","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Universal Health Protection (PUMa)","justification":""},{"idx":1,"correct":false,"proposition":"Complementary Universal Health Coverage (CMUc)","justification":""},{"idx":2,"correct":false,"proposition":"Assistance to complementary health (ACS)","justification":""},{"idx":3,"correct":false,"proposition":"Active solidarity income (RSA)","justification":""},{"idx":3,"correct":true,"proposition":"State Medical Aid (AME)","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-7-qi-5","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"This patient meets the conditions to benefit from the State Medical Aid (AME) but he has not, to date, submitted an application. Which of the following proposals for AME is correct?","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"The AME application must have been filed on the day of hospitalization","justification":""},{"idx":1,"correct":false,"proposition":"The hospital fee will remain the responsibility of the patient because he had not submitted an application for AME prior to his entry into the hospital","justification":""},{"idx":2,"correct":false,"proposition":"The AME will only allow him to access free emergency care","justification":""},{"idx":3,"correct":false,"proposition":"The AME will allow him to be reimbursed 100% of a medical consultation but he will have to advance the costs","justification":"No need to advance fees"},{"idx":4,"correct":true,"proposition":"The AME will allow him to be exempted from the medical deductible","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-7-qi-6","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"Following the information provided, the patient finally accepts the surgery and hospitalization. He was therefore taken to the operating room for an orthopedic procedure. Arriving at the operating room, the team uses the patient safety checklist << the operating room >> (2016 version) of the High Authority for Health (HAS). Which of the following proposals regarding the patient safety <<checklist in the >> operating room is which one is correct? ","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"The checklist is a barrier to recovery according to Reason's model","justification":"This is the famous model in Gruyère 🧀"},{"idx":1,"correct":false,"proposition":"The checklist checks safety points of care at 4 key moments of surgery: before anesthetic induction, before, during and after surgery","justification":""},{"idx":2,"correct":true,"proposition":"The checklist promotes the sharing of information through cross-checking","justification":""},{"idx":3,"correct":true,"proposition":"The checklist significantly reduces postoperative morbidity and mortality","justification":""},{"idx":4,"correct":false,"proposition":"The checklist must be co-signed by the surgeon, anaesthetist and patient as soon as they wake up","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-7-qi-7","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"The immediate aftermath of surgery is simple. The patient is now hospitalized. He is quickly seen by the mobile addiction team. The patient's clinical condition is stable and satisfactory. Postoperative pain is well controlled. There are no other notable clinical signs. Which of the following addiction consumption evaluation questionnaires is indicated in this patient? ","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"The Fagerstrom test","justification":""},{"idx":1,"correct":false,"proposition":"Cushman's score","justification":""},{"idx":2,"correct":true,"proposition":"The CAST questionnaire","justification":""},{"idx":3,"correct":true,"proposition":"The AUDIT questionnaire","justification":""},{"idx":4,"correct":false,"proposition":"The SPICES score","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-7-qi-8","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"During the appointment with the addictologist, in the presence of the translator, the patient reports an alcohol consumption equivalent to 6 standard drinks every day. He feels the need to have a first drink in the morning and has already been injured in a context of alcoholization in the last 12 months. The addictologist uses the AUDIT test. These elements of consumption are in favor (one or more possible answers): ","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Alcohol dependence ","justification":""},{"idx":1,"correct":false,"proposition":"The indication of a brief intervention only","justification":""},{"idx":2,"correct":true,"proposition":"Specialized addictological care","justification":""},{"idx":3,"correct":true,"proposition":"A risk of withdrawal syndrome","justification":""},{"idx":4,"correct":true,"proposition":"Misuse of alcohol","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-7-qi-9","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"As part of the prevention of alcohol withdrawal syndrome, the doctor of the department prescribes treatment with diazepam. The doctor on call is called during the following night because the patient has a state of convulsive status requiring a transfer to intensive care for 48 hours, lengthening the duration of hospitalization of this patient. Consultation of the patient's file during management by the doctor on duty shows that the patient has not received his diazepam treatment. You have no further information at this stage. How can we qualify this situation (one or more possible answers)? ","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"A risky event","justification":""},{"idx":1,"correct":true,"proposition":"An adverse event associated with care","justification":""},{"idx":2,"correct":true,"proposition":"A serious adverse event","justification":""},{"idx":3,"correct":true,"proposition":"A preventable adverse event","justification":""},{"idx":4,"correct":false,"proposition":"An unexpected side effect","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-7-qi-10","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"As part of the quality approach within the department, it is decided to investigate the causes responsible for the occurrence of this adverse event. Which method(s) is (are) suitable? ","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"A clinical audit","justification":""},{"idx":1,"correct":false,"proposition":"A clinical path","justification":""},{"idx":2,"correct":false,"proposition":"An analysis of failure modes, their effects and criticality","justification":""},{"idx":3,"correct":true,"proposition":"A mortality and morbidity review","justification":""},{"idx":4,"correct":false,"proposition":"A review of the relevance of care","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-7-qi-11","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"The analysis of this event in mortality and morbidity review aims to (one or more possible responses):","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Setting a priori the optimal care pathway","justification":"The MMR (Mortality and Morbidity Review) is carried out a posteriori, that is to say after the event has taken place."},{"idx":1,"correct":true,"proposition":"Carry out a collective analysis integrating all the professionals concerned by the event","justification":""},{"idx":2,"correct":false,"proposition":"Identify the culprit(s) at the origin of the fault","justification":"This is absolutely not the objective of quality approaches."},{"idx":3,"correct":true,"proposition":"Implement prevention, recovery or mitigation actions ","justification":""},{"idx":4,"correct":true,"proposition":"Identify root causes","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-7-qi-12","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"The ALARM method was used to identify the causes of this care-associated adverse event. The causes identified are as follows. First, a computer failure did not make it possible to carry out a computerized prescription. The prescription was made in a paper file that turned out to be that of a patient other than Mr. B. The prescription was made at the end of the morning nurses' shift. However, the computer failure was quickly resolved and the afternoon shift nurses were not informed of the computer failure. In the end, the computer failure concerned only Mr B.'s prescriptions. The prescriptions of the other patients of the department could be made on computer as is customary in this department. The patient did not speak French, and in the absence of an interpreter during hospitalization, there was a lack of communication. The nursing team was understaffed due to multiple work stoppages in the context of an influenza epidemic. The analysis of causes finds related factors (one or more possible answers):","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"To the work environment","justification":""},{"idx":1,"correct":true,"proposition":"To the organization of the service","justification":""},{"idx":2,"correct":true,"proposition":"How the team works","justification":""},{"idx":3,"correct":true,"proposition":"Patient characteristics","justification":""},{"idx":4,"correct":false,"proposition":"In the international context","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-7-qi-13","context":"Mr. B. is brought to the emergency room by an SMUR team for trauma to the right upper limb following a fight. The initial lesion assessment carried out by the out-of-hospital medical team suspects a closed fracture of the right wrist. There are also several superficial wounds on both forearms, heavily soiled with mud, which require stitches. He is 45 years old and of Afghan nationality, arrived on French territory 4 months ago, in an irregular situation. He speaks and understands only a few words of French. You benefit from a French-Afghan translator in the emergency room. He lives in a camp with the aim of crossing to the United Kingdom and has therefore not taken any steps to obtain a residence permit in France. With the help of an association, he has been domiciled with the communal centre for social action since his arrival. He has active smoking, regular alcohol and cannabis use. He has no other known history other than a proven allergy to egg protein. ","enonce":"Following this adverse event associated with care, what should be done (one or more possible responses):","item":"annales-2019-dp-7","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Inform the patient that they have experienced an unwanted event","justification":""},{"idx":1,"correct":false,"proposition":"Explain to the patient that this event would not have occurred if they did not consume so much alcohol daily","justification":""},{"idx":2,"correct":true,"proposition":"Inform the patient that every effort has been made to understand the causes of this event and prevent it from happening again","justification":""},{"idx":3,"correct":false,"proposition":"Minimize the importance of this event as it has no sequelae","justification":""},{"idx":4,"correct":false,"proposition":"Offer, if necessary, spiritual support","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-8-qi-1","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"Which of the following clinical signs are the ones that immediately point to a surgical emergency:","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"The sudden onset of pain","justification":"The criteria for a surgical emergency include: high and sudden abdominal pain, contracture (defense to a lesser extent), signs of hypovolemic shock (tachycardia, hypotension), signs of septic shock (fever), etc. "},{"idx":1,"correct":false,"proposition":"Lack of defense or contracture","justification":""},{"idx":2,"correct":false,"proposition":"The analgesic position in a gun dog","justification":"This points to acute pancreatitis"},{"idx":3,"correct":false,"proposition":"The 2 episodes of vomiting","justification":"Vomiting is not a surgical emergency"},{"idx":4,"correct":false,"proposition":"The onset of periumbilical pain","justification":"Periumbilical pain is not a worrying localization"}],"type":"dp"}
+{"_id":"annales-2019-dp-8-qi-2","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"Which of the following diagnoses you think is most likely (an expected answer):","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Acute bowel obstruction","justification":""},{"idx":1,"correct":false,"proposition":"Sigmoid diverticulitis","justification":"The location of pain is not in favor (classically in left iliac fossa \/ left flank)"},{"idx":2,"correct":false,"proposition":"Infectious ileitis","justification":"Ileitis is much less likely than occlusion."},{"idx":3,"correct":false,"proposition":"Acute cholecystitis","justification":"The localization of the pain is not in favor (classically in right hypochondrium)"},{"idx":4,"correct":false,"proposition":"Acute salpingitis","justification":"We think rather of a digestive pathology here."}],"type":"dp"}
+{"_id":"annales-2019-dp-8-qi-3","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"The pulse is at 98 beats per minute, the BP at 110\/80 mmHg and the temperature at 37.8 °C.  Regarding emergency care, what is (are) the real proposal(s)? (one or more true answers)","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Nasogastric tube placement","justification":"Systematics in case of suspected occlusion"},{"idx":1,"correct":false,"proposition":"Placement of a urinary catheter","justification":""},{"idx":2,"correct":true,"proposition":"Placement of a peripheral venous line","justification":"Good caliber track"},{"idx":3,"correct":true,"proposition":"Level 3 analgesic treatment","justification":"In view of the EVA"},{"idx":4,"correct":true,"proposition":"Blood type and rhesus"}],"type":"dp"}
+{"_id":"annales-2019-dp-8-qi-4","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"Which examination(s) do you think are useful for the management of this patient?","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Abdominal ultrasound","justification":""},{"idx":1,"correct":true,"proposition":"Abdominopelvic CT scan with contrast injection","justification":""},{"idx":2,"correct":false,"proposition":"Entero-MRI","justification":""},{"idx":3,"correct":false,"proposition":"X-ray of abdomen without face preparation","justification":"No longer 😊 done"},{"idx":4,"correct":false,"proposition":"Esogastric endoscopy","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-8-qi-5","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"An abdomino-pelvic CT scan is performed. Which of the following is correct?","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"It is an abdominal CT scan with injection, arterial time","justification":"The spleen is no longer tabby 👉 it is not arterial"},{"idx":1,"correct":false,"proposition":"This is an axial cut","justification":"Coronal Cup"},{"idx":2,"correct":false,"proposition":"The superior mesenteric artery is clouded and visible on this picture","justification":""},{"idx":3,"correct":true,"proposition":"A digestive loop is distended","justification":""},{"idx":4,"correct":true,"proposition":"There is a peritoneal effusion","justification":"Next to the liver"}],"type":"dp"}
+{"_id":"annales-2019-dp-8-qi-6","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"The CT scan confirms the hypothesis of a small bowel occlusion on flange with suffering of a small loop and presence of a peritoneal effusion. What do you propose at this stage? ","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Check the blood ionogram to adapt the ionic intake","justification":""},{"idx":1,"correct":false,"proposition":"Hospitalization, fasting, continuation of analgesic treatment and transit accelerators, clinical and biological reassessment at 24 h","justification":"Occlusion on flange + digestive suffering does not allow to wait"},{"idx":2,"correct":true,"proposition":"Contact the surgical and anesthetic team for emergency intervention","justification":""},{"idx":3,"correct":true,"proposition":"Starting intravenous probabilistic antibiotic therapy","justification":""},{"idx":4,"correct":false,"proposition":"Perform a rectosigmoidoscopy to lift the flange","justification":"Can be done in the volvulus of the sigmoid"}],"type":"dp"}
+{"_id":"annales-2019-dp-8-qi-7","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"You decide to operate on the patient. A laparotomy is performed, you discover a flange responsible for strangulation of the ileum with ischemia of the small intestine for about 1 meter. Which of the following suggestions regarding your care is true? ","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Section as quickly as possible of the flange responsible for strangulation","justification":""},{"idx":1,"correct":false,"proposition":"Rapid resection of the ischemic digestive segment to avoid bacterial translocation","justification":""},{"idx":2,"correct":true,"proposition":"Installation of moist and warm compresses in contact with the ischemic intestine and reassess its recoloration and vitality after a few minutes","justification":""},{"idx":3,"correct":true,"proposition":"The entire small intestine should be unwound to look for other flanges that may cause occlusions","justification":""},{"idx":4,"correct":true,"proposition":"You have informed the patient of the possibility of a stoma after the procedure","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-8-qi-8","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"You perform a resection-anastomosis of the hail. The patient is renourished on day 2. On the 5th day, she complains of diffuse abdominal pain, predominant at the periumbilical level. The temperature is 38.5 °C.  The examination finds a painful arch at the level of the operative scar. Which of the following diagnoses can you mention?","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"A wall abscess"},{"idx":1,"correct":true,"proposition":"An anastomotic fistula"},{"idx":2,"correct":false,"proposition":"Early recurrence of flange occlusion","justification":""},{"idx":3,"correct":true,"proposition":"A covered evisceration"},{"idx":4,"correct":false,"proposition":"A bladder globe "}],"type":"dp"}
+{"_id":"annales-2019-dp-8-qi-9","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"What test(s) do you request to support your diagnosis? (one or more responses)","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"No further examination","justification":""},{"idx":1,"correct":false,"proposition":"A suprapubic ultrasound","justification":""},{"idx":2,"correct":true,"proposition":"An abdominal CT scan with injection","justification":""},{"idx":3,"correct":false,"proposition":"An abdominal x-ray without preparation","justification":""},{"idx":4,"correct":false,"proposition":"A rectosigmoidoscopy to remove an anastomotic fistula","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-8-qi-10","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"The abdominal CT scan ordered urgently shows a wall abscess. The abscess is evacuated. The patient leaves the ward with local care at home with a 5-week absence from work. Why should she see the occupational physician again when resuming (one or more possible answers):","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Because the event occurred in the workplace","justification":""},{"idx":1,"correct":true,"proposition":"Because it's a stop of more than 30 days","justification":"The three situations that require a follow-up visit are: occupational disease, stoppage > 30J, maternity leave."},{"idx":2,"correct":true,"proposition":"To adapt the workstation if necessary","justification":""},{"idx":3,"correct":false,"proposition":"To approve!' Imputability of the accident at work","justification":""},{"idx":4,"correct":false,"proposition":"To determine the rate of disability related to the work-related accident","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-8-qi-11","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"She is seen again in consultation at his request 6 months later for the appearance of a << ball >> in front of his scar. On examination, there is an impulsive cough swelling, not painful. Which of the following diagnoses can be mentioned?","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"A covered evisceration","justification":"The peritoneum does not 👉 hold evisceration. According to the College of Digestive Surgery: 'Early post-operative injury'"},{"idx":1,"correct":true,"proposition":"An uncomplicated eventration","justification":"The peritoneum holds 👉 ventration. According to the College of Digestive Surgery: 'Hernia through an opening secondary to a previous incision'"},{"idx":2,"correct":false,"proposition":"A recurrence of the wall abscess","justification":""},{"idx":3,"correct":false,"proposition":"A keloid scar","justification":""},{"idx":4,"correct":false,"proposition":"A parietal lipoma","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-8-qi-12","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"Given the impulsive nature of coughing and not painful, you evoke an uncomplicated eventration. Do you inform the patient that? ","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Wearing a restraint belt for 6 months prevents their occurrence","justification":""},{"idx":1,"correct":true,"proposition":"An eventration always occurs on an acquired aponeurotic orifice","justification":"This is the definition 😊"},{"idx":2,"correct":true,"proposition":"Surgery is responsible for venting in the majority of cases","justification":"It is exceptionally post-traumatic."},{"idx":3,"correct":false,"proposition":"She should have had a work stoppage of at least 3 months to prevent the ventration","justification":""},{"idx":4,"correct":true,"proposition":"The occurrence of a parietal abscess is a risk factor for the occurrence of eventration","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-8-qi-13","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"You propose to the patient a surgical cure of the eventration. But she refuses this intervention. Three years later, she was admitted urgently for acute abdominal pain. Which of the following proposals will direct you towards the diagnosis of strangled ventration? ","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Painful swelling","justification":""},{"idx":1,"correct":true,"proposition":"Irreducibility of eventration","justification":""},{"idx":2,"correct":true,"proposition":"Occurrence of iterative vomiting","justification":""},{"idx":3,"correct":false,"proposition":"Conjunctival jaundice","justification":""},{"idx":4,"correct":true,"proposition":"Loss of impulsivity at cough","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-8-qi-14","context":"A 42-year-old patient visits the emergency department for acute abdominal pain. She is a hostess, has no personal or family medical history apart from a balanced migraine pathology under treatment. She underwent surgery at the age of 14 for acute appendicitis. She is on oral contraception. The pain came abruptly while she was at her workstation. It began in the periumbilical region and then spread to the entire abdomen. She was not relieved by taking paracetamol (1g) or by the 2 vomiting or diarrheal episode she had. She has no fever. On inspection, the patient lies down like a gun dog. The physical examination finds diffuse abdominal pain without contracture or defense on palpation. The pain is rated at 8\/10 on the EVA scale.","enonce":"You make the diagnosis of strangulated ventration and the patient is operated urgently. There is no digestive suffering and the fascia is closed by a simple suture. The postoperative follow-up is simple and the patient leaves the service at 5 quality of general practitioner, you see the patient again 8 days later at home and you inform her ","item":"annales-2019-dp-8","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"That, in its situation, the aponeurotic suture guarantees the absence of recurrence in 90% of cases","justification":""},{"idx":1,"correct":false,"proposition":"That the wearing of a restraint belt is recommended 24 hours a day","justification":""},{"idx":2,"correct":true,"proposition":"That it would be advisable to contact the occupational physician of his company","justification":""},{"idx":3,"correct":true,"proposition":"That in case of recurrence of its eventration, the installation of a parietal reinforcement prosthesis would be recommended","justification":""},{"idx":4,"correct":false,"proposition":"That you cannot ask his surgeon for his entire hospitalization file because of medical confidentiality","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-9-qi-1","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"Which of the following are the clinically severe symptoms(s) you are looking for in this child:  ","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"The child does not respond to the pain","justification":"In both children and adults, it is a sign of clinical seriousness"},{"idx":1,"correct":true,"proposition":"Heart rate is at 60 beats per minute","justification":"The threshold is 80 bpm"},{"idx":2,"correct":true,"proposition":"Breathing is irregular","justification":""},{"idx":3,"correct":true,"proposition":"She has fever and a rash that persists on vitropressure","justification":"The rash that persists with vitropressure is purpura, i.e. blood extravasation (blood coming out of the vessels). Any febrile purpura is a fulminans purpura until proven otherwise, and requires the introduction of antibiotic therapy as a matter of absolute urgency (even before bacteriological sampling if these delay management)."},{"idx":4,"correct":false,"proposition":"There is a notion of recent travel","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-9-qi-2","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"There is no rash or fever. In the absence of a verbal and motor response described by the mother as well as breathing that you hear as very slow and noisy, you send a team home. On the spot the doctor notes: a heart rate at 80 \/ min, a respiratory rate at 10 \/ min, a pink but sleepy child with a Glasgow score at 11, the temperature is at 36.2 ° C, skin recoloration is immediate and blood pressure is 102\/61 mmHg. The pupils are symmetrical and responsive, the nape is flexible. The mother does not report any unusual items in the previous days (no fever, no trauma). Which diagnosis(s) are compatible with this clinical picture? ","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Bacterial meningitis","justification":"The pupils are symmetrical and responsive, the nape is flexible."},{"idx":1,"correct":true,"proposition":"Trauma inflicted","justification":""},{"idx":2,"correct":true,"proposition":"Status epilepticus","justification":"a pink but sleepy child with a Glasgow score of 11"},{"idx":3,"correct":true,"proposition":"Exogenous poisoning","justification":""},{"idx":4,"correct":true,"proposition":"Hereditary abnormality of metabolism","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-9-qi-3","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"Regarding the hypothesis of a inflicted head trauma, what is (are) the exact proposal(s) in this pathology? ","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"The age of the child is evocative","justification":""},{"idx":1,"correct":false,"proposition":"The absence of impact on the skull excludes this diagnosis","justification":""},{"idx":2,"correct":false,"proposition":"Disorders of consciousness are rare","justification":""},{"idx":3,"correct":true,"proposition":"The break of the cranial perimeter curve is suggestive","justification":""},{"idx":4,"correct":true,"proposition":"Look for a subdural hematoma","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-9-qi-4","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"As a general rule, under what circumstances can bradypnea be observed in children? ","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"In case of opiate poisoning","justification":""},{"idx":1,"correct":false,"proposition":"In case of metabolic acidosis","justification":"Polypnea"},{"idx":2,"correct":true,"proposition":"In case of hypoxia","justification":""},{"idx":3,"correct":false,"proposition":"In case of carbon monoxide poisoning","justification":"Neurological impairment"},{"idx":4,"correct":false,"proposition":"In case of paracetamol poisoning","justification":"Liver damage"}],"type":"dp"}
+{"_id":"annales-2019-dp-9-qi-5","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"The arterial gas balance made under oxygen is as follows: pH 7.26, PCO2 66 mmHg, Bicarbonates 24 mmol \/ L, HbCO 3%, PO2 90 mmHg. How do you interpret this balance sheet (only one answer)? ","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Compensated respiratory acidosis","justification":""},{"idx":1,"correct":true,"proposition":"Uncompensated respiratory acidosis","justification":"Acidosis because pH<7.35 (or 7.38 depending on the source). Respiratory because the drop in pH is caused by the increase in pCO2 (which is > 45). Not compensated because the pH is acidic."},{"idx":2,"correct":false,"proposition":"Compensated metabolic acidosis","justification":""},{"idx":3,"correct":false,"proposition":"Uncompensated metabolic acidosis","justification":""},{"idx":4,"correct":false,"proposition":"Mixed acidosis","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-9-qi-6","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"The child is admitted to the emergency room where you decide to perform a brain scan and prescribe a urine toxicity test. Which symptom(s) is compatible with drug poisoning? (one or more exact propositions)","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Urinary retention","justification":""},{"idx":1,"correct":true,"proposition":"Cyanosis","justification":""},{"idx":2,"correct":false,"proposition":"Hives","justification":""},{"idx":3,"correct":true,"proposition":"Nausea and vomiting","justification":""},{"idx":4,"correct":false,"proposition":"Pupillary asymmetry","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-9-qi-7","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"Here are the growth curves that you reconstitute in the health record. What diagnostic hypothesis(s) can (s) be evoked when reading these curves?","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Hydrocephalus"},{"idx":1,"correct":false,"proposition":"Craniopharyngioma"},{"idx":2,"correct":true,"proposition":"Congenital immunodeficiency","justification":""},{"idx":3,"correct":false,"proposition":"Syndrome de Turner"},{"idx":4,"correct":true,"proposition":"Psychosocial dwarfism"}],"type":"dp"}
+{"_id":"annales-2019-dp-9-qi-8","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"The search for toxic substances finds cannabis. The mother reports that her husband had friends the day before and that it is possible that they had left cannabis resin on the coffee table that the child would have ingested at the time. You also note on clinical examination gingival hypertrophy, cavities, pallor, some petechiae in the lower limbs. What first-line investigation(s) is (are) necessary in view of these growth charts and clinical signs?","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"A complete blood count","justification":"Because of petechiae and pallor"},{"idx":1,"correct":false,"proposition":"An X-ray of a skull","justification":""},{"idx":2,"correct":false,"proposition":"A weight assay of immunoglobulins","justification":""},{"idx":3,"correct":false,"proposition":"A FSH-LH assay","justification":""},{"idx":4,"correct":false,"proposition":"A CMV serology","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-9-qi-9","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"The complete blood count shows a hemoglobin of 9.8 g\/dL, with a MCV of 68 fL, the platelet count of 525 G\/L. Which of the following do you think is the most likely diagnosis based on history, clinical signs and laboratory results? ","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Nutritional deficiency","justification":"Anemia is probably iron deficiency"},{"idx":1,"correct":false,"proposition":"Crohn's disease","justification":""},{"idx":2,"correct":false,"proposition":"Cystic fibrosis","justification":""},{"idx":3,"correct":false,"proposition":"Biermer's disease","justification":"Anemia would be rather macrocytic"},{"idx":4,"correct":false,"proposition":"Hepatocellular insufficiency","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-9-qi-10","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"The dietary survey confirms your hypothesis of serious deficiency on an inadequate diet, since the child drinks only semi-skimmed cow's milk, sugary drinks and nibbles cakes. Regarding the recommended dietary and vitamin allowances at this age, which is (are) accurate? ","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Fluoride supplementation is recommended for all children from birth","justification":"You don't have teeth at birth 🦷😬"},{"idx":1,"correct":false,"proposition":"A vitamin C supplement is necessary in winter","justification":""},{"idx":2,"correct":false,"proposition":"Growing up milk can be replaced by cow's milk from 18 months","justification":""},{"idx":3,"correct":false,"proposition":"Breastfeeding provides adequate iron intake at this age","justification":""},{"idx":4,"correct":true,"proposition":"Infant formulas are fortified with vitamin D","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-9-qi-11","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"You consult his health record. At 2 months: hexavalent and pneumococcal conjugate vaccine with 13 valences. at 6 months: hexavalent and pneumococcal conjugate vaccine with 13 valences. At 7 months: meningococcal C. vaccination at 12 months: hexavalent and pneumococcal conjugate vaccine with 13 valences. There has been no medical examination since the age of 12 months. Regarding the vaccination recommendations in force for this 18-month-old infant, what is the exact proposal(s)? (one or more true propositions)","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Meningococcal C vaccine is missing","justification":"Two in total"},{"idx":1,"correct":true,"proposition":"One dose of hepatitis vaccine is missing","justification":"3 total"},{"idx":2,"correct":true,"proposition":"At least one dose of measles\/mumps\/rubella (MMR) vaccine is missing","justification":"2 in total, at 12 then 16-18 months"},{"idx":3,"correct":false,"proposition":"One dose of 23-valent pneumococcal polysaccharide vaccine is missing","justification":"13 valances"},{"idx":4,"correct":false,"proposition":"Missing dose of varicella vaccine","justification":"No mandatory varicella vaccine, nor recommended at this age (it is in adolescents and adults who were not infected in childhood)"}],"type":"dp"}
+{"_id":"annales-2019-dp-9-qi-12","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"You are also worried about the psychomotor development of this 18-month-old child, who has very little stimulation from parents and spends her days in front of the television screen. Which of these propositions is (are) accurate?","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Walking must be acquired","justification":""},{"idx":1,"correct":true,"proposition":"The child knows how to drink alone","justification":""},{"idx":2,"correct":false,"proposition":"Their language must be at least 100 words long","justification":""},{"idx":3,"correct":true,"proposition":"It combines 2 to 3 words","justification":""},{"idx":4,"correct":true,"proposition":"The child can stack 2 cubes","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-9-qi-13","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"This child's language is dissyllabic, she does not associate two words and does not react to the call of her name. She stands alone and takes a few steps when invited but is spontaneously << very calm >>. Which of the following investigations should be carried out in the first line? ","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"An ENT consultation for audiometry","justification":"Deafness must be eliminated in front of this clinical description. It is a common cause of delayed psychomotor development."},{"idx":1,"correct":false,"proposition":"A CPK assay","justification":""},{"idx":2,"correct":false,"proposition":"Evoked potentials of the brainstem","justification":""},{"idx":3,"correct":false,"proposition":"An electromyogram","justification":""},{"idx":4,"correct":false,"proposition":"An ophthalmological examination","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-9-qi-14","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"The ENT consultation finds normal hearing, you retain a deficiency origin to this psychomotor delay. Faced with this table of accidental poisoning and serious deficiency of food intake, irregular medical monitoring (with vaccination delay), what step(s) do you think is necessary? (one or more true propositions)","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"A phone call from the gendarmerie","justification":"This is not the regulatory route"},{"idx":1,"correct":true,"proposition":"A report to the public prosecutor","justification":""},{"idx":2,"correct":false,"proposition":"A report to the Regional Health Agency","justification":"The ARS is not concerned"},{"idx":3,"correct":false,"proposition":"Worrying information at the High Authority of Health (HAS)","justification":"The HAS is not concerned"},{"idx":4,"correct":false,"proposition":"A phone call to the child's doctor and the Maternal Child Protection","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-9-qi-15","context":"You are on duty at the telephone regulation service of the UAS, you are given the call of the mother of an 18-month-old child. She worries because her child went back to sleep at 10am and she can't wake her up. The child had gotten up around 7 a.m. and was fine. This child has no notable history, she was born eutrophic at term after a normal pregnancy.","enonce":"You write a judicial report. Which of the following is correct? ","item":"annales-2019-dp-9","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"The name of the medical writer(s) must remain anonymous","justification":"It must be clearly identified"},{"idx":1,"correct":false,"proposition":"He must suggest the person responsible for the abuse","justification":"It must be objective and descriptive"},{"idx":2,"correct":false,"proposition":"It must be given to both parents","justification":"Parents may be informed, unless the child is in the best interests of the contrary"},{"idx":3,"correct":true,"proposition":"It must mention the identity of the persons holding parental authority","justification":""},{"idx":4,"correct":false,"proposition":"Parents must be informed of the report","justification":"Unless otherwise interested of the child"}],"type":"dp"}
+{"_id":"annales-2019-dp-11-qi-1","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"What element(s) do you look for in the clinical examination of the patient who may participate in infertility? ","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Positive Prehn's sign","justification":"We do not think of acute orchitis in this context"},{"idx":1,"correct":true,"proposition":"Unilateral gynecomastia","justification":""},{"idx":2,"correct":true,"proposition":"Cryptorchidism","justification":""},{"idx":3,"correct":true,"proposition":"Hair abnormality","justification":""},{"idx":4,"correct":false,"proposition":"Ligament hyperlaxity","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-11-qi-2","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"The patient has already made a spermogram after 4 days of abstinence of which he shows you the results: ejaculated volume at 5 ml, sperm concentration: 2 million \/ ml, total sperm motility: 10%, 75% spermatozoa, 1% normal forms. What are the exact proposal(s)?","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"There is hypospermia","justification":"Threshold at 1.5 mL"},{"idx":1,"correct":true,"proposition":"There is oligospermia","justification":"Threshold at 15 million\/mL"},{"idx":2,"correct":true,"proposition":"There is teratospermia","justification":"1% is not much 😉"},{"idx":3,"correct":false,"proposition":"There is necrospermia","justification":"Well, we don't know what the 75% means (are these normal or dead spermatozoa?), so we don't tick"},{"idx":4,"correct":true,"proposition":"There is asthenospermia","justification":"10% mobility is not much at all 😅"}],"type":"dp"}
+{"_id":"annales-2019-dp-11-qi-3","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"No etiology is found to these spermogram abnormalities explaining infertility and pregnancy is obtained by intracytoplasmic injection of spermatozoa. The 1 trimester of pregnancy passes without difficulty except for nausea and some bleeding of red blood. The patient consults at 27 SA because her last two urine strips showed the presence of leukocytes and nitrites. She has no fever, no urinary symptoms apart from slight cough leakage. She has had a recurrent cough since the beginning of winter. She therefore restricts herself from drinking to limit leakage. What is the most likely diagnosis? (only one answer expected)","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Urogenital tuberculosis","justification":""},{"idx":1,"correct":false,"proposition":"Cystitis","justification":""},{"idx":2,"correct":true,"proposition":"Urinary colonization","justification":""},{"idx":3,"correct":false,"proposition":"Molar pregnancy","justification":""},{"idx":4,"correct":false,"proposition":"Bladder lithiasis","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-11-qi-4","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"You have a cytobacteriological examination of urine performed which shows: 42000 red blood cells \/ ml, 12000 leukocytes per mL, and 10 power 5 E. Coli \/ mL in culture. What do you do?","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Amoxicillin treatment should be started as a first-line treatment","justification":""},{"idx":1,"correct":false,"proposition":"First-line fosfomycin-trometamol therapy should be started","justification":""},{"idx":2,"correct":true,"proposition":"It is necessary to wait for the results of the susceptibility test to treat","justification":""},{"idx":3,"correct":false,"proposition":"Intravenous dual antibiotic therapy is needed","justification":""},{"idx":4,"correct":true,"proposition":"There is a risk of acute pyelonephritis if left untreated","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-11-qi-5","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"Escherichia coli colonization recurs several times during pregnancy and required 4 lines of antibiotic treatment. The patient gives birth at 38 SA+ 4 J of a little girl of 4180 g vaginally without episiotomy. Three weeks later, she consults for an alteration of the general condition, a fever at 38.8 ° C, urinary functional signs such as pollakiuria and leakage with effort and pain that she has difficulty systematizing but predominant in the right hemiabdomen. Her daughter is formula-fed and is doing well. What diagnosis(s) are possible at this stage? ","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Cystitis","justification":""},{"idx":1,"correct":true,"proposition":"Endometritis","justification":""},{"idx":2,"correct":true,"proposition":"Pyelonephritis","justification":""},{"idx":3,"correct":false,"proposition":"Renal colic","justification":""},{"idx":4,"correct":true,"proposition":"Pelvic thrombophlebitis","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-11-qi-6","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"On clinical examination the vaginal touch is painless, the breasts are flexible, there is pain at the shaking of the right lumbar fossa with a painful path radiating in addition pubic. Cardiopulmonary auscultation finds a decrease in vesicular murmur in the right base. The patient is febrile at 38.7°C, heart rate is 132\/min and blood pressure is 87\/53 mmHg. Which exam(s) are you asking for as a first line?","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Doppler ultrasound of the lower limbs","justification":""},{"idx":1,"correct":true,"proposition":"Cytobacteriological examination of urine","justification":""},{"idx":2,"correct":true,"proposition":"Renal imaging"},{"idx":3,"correct":false,"proposition":"D-dimer"},{"idx":4,"correct":true,"proposition":"Blood"}],"type":"dp"}
+{"_id":"annales-2019-dp-11-qi-7","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"The imagery is as follows. Which proposal(s) is the exact proposal(s): (one or more expected proposals)","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"These are cuts of abdominal-pelvic CT scan after injection of contrast medium","justification":""},{"idx":1,"correct":true,"proposition":"There is dilation of the right pyelocalicial cavities","justification":""},{"idx":2,"correct":false,"proposition":"There is a right pyelic calculation","justification":""},{"idx":3,"correct":true,"proposition":"There is a right ureteral calculus","justification":""},{"idx":4,"correct":false,"proposition":"There is a syndrome of right kidney mass","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-11-qi-8","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"The abdominopelvic CT scan therefore shows a dilation of the right pyelocalicial cavities upstream of a 7 mm ureteral stone. Direct examination of urine shows the presence of leukocytes, red blood cells and gram-negative bacilli. As she returned from the CT scan, the patient's blood pressure dropped to 65\/30 mmHg and the lumbar fossa pain intensified. Her state of consciousness is normal, she has some mottling on her knees. What therapeutic measure(s) is possible in the first line? ","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"No measures should delay surgical management","justification":""},{"idx":1,"correct":true,"proposition":"Crystalloid-like solute filling","justification":""},{"idx":2,"correct":false,"proposition":"Parenteral bi-antibiotic therapy with fluoroquinolone and aminoglycoside","justification":""},{"idx":3,"correct":true,"proposition":"Parenteral bi-antibiotic therapy with beta-lactam and aminoglycoside","justification":""},{"idx":4,"correct":true,"proposition":"Administration of vasopressive drug type noradrenaline","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-11-qi-9","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"The patient responds well to crystalloid filling and her blood pressure is now stabilized at 100\/58 mmHg. What additional therapeutic measure do you propose in this context? (only one answer expected)","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Nonsteroidal anti-inflammatory drugs","justification":""},{"idx":1,"correct":true,"proposition":"Urine drainage by JJ or ureteral tube","justification":""},{"idx":2,"correct":false,"proposition":"Urine drainage by bladder tube alone","justification":""},{"idx":3,"correct":false,"proposition":"Ureteroscopy for stone extraction after 48 h of effective antibiotic therapy","justification":""},{"idx":4,"correct":false,"proposition":"Ureteral drainage by JJ tube after 48 h of effective antibiotic therapy","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-11-qi-10","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"After the placement of a JJ tube (non-purulent urine) and 72 hours of adapted antibiotic therapy, the patient's clinical condition improves and she can go home. You see it again in consultation 1 month later and the CT scan without injection shows that the stone has been pushed back into the upper calyx. It always measures 7 mm and its density is 1050 UH. The JJ tube is quite poorly tolerated with pollakiuria and almost permanent pain. What are the possible measures for the continuation of the care (one or more correct answers):","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"JJ probe removal and monitoring","justification":""},{"idx":1,"correct":true,"proposition":"Extracorporeal lithotripty","justification":""},{"idx":2,"correct":true,"proposition":"Ureteroscopy extraction","justification":""},{"idx":3,"correct":false,"proposition":"Percutaneous nephrolithotomy","justification":""},{"idx":4,"correct":false,"proposition":"Iterative changes to the JJ probe","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-11-qi-11","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"You finally decide to perform a flexible ureteroscopy with extraction of all the lithiasic fragments that are sent for analysis. Given the elements at your disposal, what is the most likely majority component of this calculation? ","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Calcium oxalate","justification":""},{"idx":1,"correct":false,"proposition":"Struvite","justification":""},{"idx":2,"correct":false,"proposition":"Medicated lithiasis","justification":""},{"idx":3,"correct":false,"proposition":"Cystine","justification":""},{"idx":4,"correct":false,"proposition":"Uric acid","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-11-qi-12","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"Infrared spectrophotometry concludes that it is a calculation composed of 75% whewellite (calcium oxalate monohydrate), 25% wedellite (calcium oxalate dihydrate). What can be the contributing factor(s) of such a calculation in this patient?","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Primary hyperparathyroidism","justification":""},{"idx":1,"correct":false,"proposition":"Hypocalciuria"},{"idx":2,"correct":false,"proposition":"Recurrent urinary tract infections","justification":""},{"idx":3,"correct":true,"proposition":"Inadequate water intake","justification":""},{"idx":4,"correct":false,"proposition":"Protein intakes too low","justification":"Too important"}],"type":"dp"}
+{"_id":"annales-2019-dp-11-qi-13","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"The first-line etiological assessment you prescribed is normal. What recurrence prevention measure(s) are you putting in place?","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Decreased calcium intake (< 400 mg\/d)","justification":"800-1000 mg\/day"},{"idx":1,"correct":true,"proposition":"Decrease in sodium intake (6 g\/d)","justification":""},{"idx":2,"correct":false,"proposition":"Hydration for a diuresis volume of about 1 L","justification":"2L"},{"idx":3,"correct":false,"proposition":"Alkalization of urine"},{"idx":4,"correct":false,"proposition":"Weekly antibiotic prophylaxis","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-11-qi-14","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"The patient comes back to see you 4 years later because she thinks her stones are recurring. However, she experienced a second pregnancy without lithiasis recurrence and gave birth without difficulty to a little boy weighing 3560 grams 18 months ago. For the past few weeks, she has felt embarrassed by a bladder stone that frequently makes her want to urinate day and night. She feels pelvic heaviness aggravated by prolonged standing. Her needs are so urgent that she can't always restrain herself. On the other hand, his cough leaks disappeared except possibly in the morning when he woke up. Sexual intercourse is unpleasant. What is the most likely diagnostic hypothesis?","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Lithiasis enclosed in the urethra","justification":""},{"idx":1,"correct":false,"proposition":"Urinary tract infection","justification":""},{"idx":2,"correct":true,"proposition":"Genital prolapse","justification":""},{"idx":3,"correct":false,"proposition":"Carcinoma in situ","justification":""},{"idx":4,"correct":true,"proposition":"uterine fibroid","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-11-qi-15","context":"A couple consults for infertility. The woman is 28 years old and has no family history. She has never traveled or had unprotected sex except with her current partner, and has a personal history of recurrent epistaxis, active smoking for 10 packs years, allergy to pollen and dust mites, and abdominal surgery for appendectomy at the age of 21. The spouse is 36 years old, has smoked 1 pack a day since the age of 17 and occasionally uses cannabis. He has no medical-surgical history. They have been living in a relationship for 6 years, have not used contraception for 14 months and have sex several weeks. The gynaecologist who treats the patient did not find any ovarian or uterine abnormalities. The patient's hormonal balance is normal.","enonce":"Your clinical examination confirms the presence of a grade 3 anterior colpocele. What is the most plausible explanation for the disappearance of stress urinary incontinence: (one exact proposition)","item":"annales-2019-dp-11","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Lithiasis enclosed in the urethra","justification":""},{"idx":1,"correct":false,"proposition":"Childbirth-related synechia","justification":""},{"idx":2,"correct":true,"proposition":"Plication of the urethra by the colpocele","justification":""},{"idx":3,"correct":false,"proposition":"Sequelae of urinary tract infections","justification":""},{"idx":4,"correct":false,"proposition":"Urethral calcification by calcium oxalate","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-12-qi-1","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"What is the most relevant information to look for during the interview or clinical examination? ","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Abdominal pain","justification":"The main question is: is it a GEU? The absence of abdominal pain would then be very reassuring."},{"idx":1,"correct":false,"proposition":"An open neck","justification":""},{"idx":2,"correct":false,"proposition":"Abundant metrorrhagia","justification":""},{"idx":3,"correct":false,"proposition":"A uterus too large for the term","justification":""},{"idx":4,"correct":false,"proposition":"An exacerbation of sympathetic signs of pregnancy","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-12-qi-2","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"In this patient, physical examination reveals moderate pain caused in the defenseless right iliac fossa. Blood pressure is at 130\/70 mmHg. The heart rate is at 80 bpm. The uterus is impalpable due to the patient's overweight. On examination under speculum, moderate red bleeding comes from the endocervix. At vaginal touch, there is no mass, but palpation of the right cul-de-sac triggers moderate pain. Which diagnosis do you prefer at this stage of management? ","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Ectopic pregnancy","justification":"Priority is always given to the most serious and urgent 😉"},{"idx":1,"correct":false,"proposition":"Non-progressive intrauterine pregnancy","justification":""},{"idx":2,"correct":false,"proposition":"Molar pregnancy","justification":""},{"idx":3,"correct":false,"proposition":"Active intrauterine pregnancy","justification":""},{"idx":4,"correct":false,"proposition":"Spontaneous abortion in progress","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-12-qi-3","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"Following your clinical examination, you decide to perform an endovaginal pelvic ultrasound. Which ultrasound sign(s) would be compatible with the diagnosis of ectopic pregnancy?","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Thickening of the endometrium","justification":""},{"idx":1,"correct":true,"proposition":"Absence of effusion in the rectouterine cul-de-sac (Douglas)","justification":""},{"idx":2,"correct":true,"proposition":"Absence of visible right laterouterine mass","justification":""},{"idx":3,"correct":true,"proposition":"Corpus luteum on the right ovary","justification":""},{"idx":4,"correct":true,"proposition":"Hypoechoic intrauterine image without hyperechoic crown","justification":"Everything is 'compatible'"}],"type":"dp"}
+{"_id":"annales-2019-dp-12-qi-4","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"The pelvic ultrasound you perform shows uterine emptiness, no intra-abdominal effusion and no visible adnexal mass. Plasma HCG is measured at 900 IU\/L. What therapeutic strategy do you adopt (only one expected response)?","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Intramuscular injection of methotrexate on an outpatient basis","justification":""},{"idx":1,"correct":false,"proposition":"Laparoscopy explorer","justification":""},{"idx":2,"correct":false,"proposition":"Administration of oral misoprostol on an outpatient basis","justification":""},{"idx":3,"correct":true,"proposition":"Expectancy and reassessment within 48 h with new HCG assay and control ultrasound","justification":""},{"idx":4,"correct":false,"proposition":"Endorish aspiration with sending of samples in anatomical pathology for chorionic villus testing","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-12-qi-5","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"You see the patient again two days later. She still feels a slight pain in the right iliac fossa. Minimal metrorrhagia persist. The HCGs are at 1200 in the same laboratory. The control ultrasound reveals this time a hematosalpinx of 20mm on the right, without visible embryo and without abdominal effusion. Your increased suspicion of ectopic pregnancy therefore leads you to prescribe methotrexate. Which proposals are correct?","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Folic acid should be systematically combined","justification":""},{"idx":1,"correct":true,"proposition":"A transient increase in HCG is usual","justification":""},{"idx":2,"correct":false,"proposition":"It may be accompanied by hand-foot syndrome","justification":""},{"idx":3,"correct":true,"proposition":"The success rate is correlated with the HCG rate","justification":""},{"idx":4,"correct":false,"proposition":"A tubal rupture can occur","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-12-qi-6","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"What advice(s) do you give to the patient? ","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Absolute contraindication to microprogestogens","justification":""},{"idx":1,"correct":false,"proposition":"Need for early pelvic ultrasound in case of new pregnancy","justification":"We have not found this notion even if it would seem logical 🤔 to us"},{"idx":2,"correct":false,"proposition":"Respect a minimum of 6 months after the injection of methotrexate to start a new pregnancy","justification":"The recommended period is 3 months"},{"idx":3,"correct":true,"proposition":"Smoking cessation","justification":"Always always"},{"idx":4,"correct":false,"proposition":"Perform a hysterosalpingography to assess tubal patency","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-12-qi-7","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"Two years after the management of this ectopic pregnancy, the patient returns to consult as part of the follow-up of a new pregnancy. This pregnancy is desired. It is at 12 SA. She has no symptoms. It brings you the result of the early pregnancy assessment prescribed by its general practitioner: blood group O rhesus negative, negative search for irregular agglutinins, rubella serology IgG +, serology toxoplasmosis IgG + \/ lgM-, HBsAg-, TPHA-VDRL-, HIV serology- You take the opportunity to perform a urine strip, it reveals 2 blood crosses and 2 protein crosses, no leukocytes or nitrites. Blood pressure is measured at 130\/80 mmHg. What is (are) your prescription(s)? ","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Quantification of urinary red blood cells by ECBU","justification":"Positive BU -> ECBU of confirmation and precision"},{"idx":1,"correct":true,"proposition":"Renal ultrasound","justification":""},{"idx":2,"correct":false,"proposition":"Cystoscopy","justification":""},{"idx":3,"correct":true,"proposition":"Proteinuria\/creatinine ratio","justification":""},{"idx":4,"correct":false,"proposition":"Uroscanner","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-12-qi-8","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"The next day (12+1 SA), you receive the results of the prescribed examinations. The ECBU is sterile 3 but confirms a red blood cell rate of 10 red blood cells\/mm. The proteinuria\/creatinine ratio is 40 mg\/mmol. Ultrasound shows the absence of kidney malformation and normal-sized kidneys without macroscopic cysts as well as a bladder without abnormalities. The plasma creatinine assay is 50 micromoL\/L. What etiology(ies) is (are) compatible with the whole picture presented by this patient?","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Pre-eclampsia"},{"idx":1,"correct":true,"proposition":"Alport syndrome"},{"idx":2,"correct":false,"proposition":"Stenosis of the renal arteries","justification":""},{"idx":3,"correct":true,"proposition":"lgA nephropathy"},{"idx":4,"correct":false,"proposition":"Autosomal dominant polycystic disease","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-12-qi-9","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"Given the probable existence of nephropathy pre-existing to pregnancy, a consultation with a nephrologist is scheduled. In the absence of renal failure, the latter provides for a renal biopsy to be performed once the pregnancy is over. \nThe monitoring of pregnancy subsequently proves satisfactory, especially in terms of blood pressure. At 31 weeks, the patient consults for decreased fetal active movements. She is also asymptomatic. Its temperature is 37 °C.  His blood pressure is 140\/80 mmHg. The uterine height is measured at 26 cm. His osteotendinous reflexes are normal. Fetal cardio monitoring is normal. \nYou perform a fetal ultrasound. Fetal biometrics include: biparietal diameter at 258 percentile, cephalic perimeter at 308 percentile, abdominal perimeter at 58 percentile, femur length 48 percentile, fetal weight estimate at 38 percentile. The uterine Doppler has a decreased diastole on both sides, without notch. The umbilical Doppler has zero diastole. The cerebral Doppler has an increased diastole. There is no visible fetal malformation. The amount of amniotic fluid is decreased. \nWhat argument(s) support(s) the hypothesis of a vasculo-placental cause that can explain these biometrics?","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Decreased diastole on uterine Doppler","justification":""},{"idx":1,"correct":true,"proposition":"Decreased amount of amniotic fluid","justification":""},{"idx":2,"correct":false,"proposition":"Absence of uterine Doppler \"notch\"","justification":"It is a present notch that directs us to a vascular cause"},{"idx":3,"correct":true,"proposition":"Preserved cephalic biometrics","justification":""},{"idx":4,"correct":true,"proposition":"Increased diastole on cerebral Doppler","justification":"This is a sign of brain adaption"}],"type":"dp"}
+{"_id":"annales-2019-dp-12-qi-10","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"Given this small fetus for gestational age, you decide to hospitalize the patient for fetal heart rate monitoring 3 times a day. What therapeutic measure(s) do you decide to implement? ","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Fetal lung maturation corticosteroid therapy","justification":"<34 Ltd"},{"idx":1,"correct":false,"proposition":"Tocolysis by atosiban","justification":""},{"idx":2,"correct":false,"proposition":"Magnesium sulphate","justification":"< 32 SA if imminent delivery for the baby potit or if neuros signs in front of pre-eclampsia for the mother potitis"},{"idx":3,"correct":false,"proposition":"Central antihypertensive","justification":""},{"idx":4,"correct":false,"proposition":"Low-dose aspirin","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-12-qi-11","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"After 24 hours of hospitalization, the patient's condition deteriorates. Blood pressure is now measured at 150\/100 mmHg. The patient complains of headache and epigastric pain. His diuresis is quantified at 200 ml since his hospitalization. The reflexes are sharp, diffused and polykinetic. Cardiofetal monitoring is not very oscillating with decelerations. You perform an emergency biological assessment, the results are as follows: platelets 60 G \/ L, hemoglobin 9 g \/ dL, schizocytes positive, haptoglobin 0.2 g \/ l, asat 230 IU \/ L, ALAT 340 IU \/ L. What are the priority therapeutic measures (one or more exact answers)? ","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Second injection of corticosteroids","justification":""},{"idx":1,"correct":true,"proposition":"Prevention of eclampsia by magnesium sulfate","justification":""},{"idx":2,"correct":true,"proposition":"Fetal extraction","justification":"This is an absolute emergency"},{"idx":3,"correct":false,"proposition":"Transfusion of red blood cells","justification":""},{"idx":4,"correct":false,"proposition":"Intravenous antihypertensive","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-12-qi-12","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"An emergency caesarean section is performed. The patient gives birth to a 1020 g girl cared for by the neonatal team. Breastfeeding is maternal. At 72 hours, maternal progress is satisfactory. High blood pressure has disappeared, as have headaches. Osteotendinous reflexes have normalized. Diuresis resumed normally. Maternal work-up also improved in the first 48 hours after delivery with the disappearance of HELLP syndrome. On day 4, the patient presents with fever at 38.5°C and significant hypogastric pelvic pain. His blood pressure is 130\/70 mmHg and his pulse is 90 bpm. Examination with the speculum reveals smelly lochia mixed with blood in small quantities. The caesarean section scar is clean. The breasts are tense, painful as a whole, without inflammatory cupboard or palpable mass. There is no axillary lymphadenopathy. The patient has not had a venous route or urinary catheter for 48 hours. No preventive anticoagulant therapy was initially initiated due to HELLP syndrome. What is the diagnosis you mention first? ","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Salpingitis","justification":""},{"idx":1,"correct":false,"proposition":"Pelvic abscess","justification":""},{"idx":2,"correct":true,"proposition":"Endometritis","justification":""},{"idx":3,"correct":false,"proposition":"Pelvic thrombophlebitis","justification":""},{"idx":4,"correct":false,"proposition":"Following an intraoperative perforation","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-12-qi-13","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"You perform a pelvic ultrasound in front of this suspicion of endometritis. A small placental retention measured 15 mm in sagittal section of the uterus is observed. What is (are) the element(s) of your therapeutic management? ","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Ceftriaxone and intravenous metronidazole","justification":"It's augmentin now (new reco 2021)"},{"idx":1,"correct":true,"proposition":"Endouterine aspiration in the operating room","justification":""},{"idx":2,"correct":false,"proposition":"Stopping breastfeeding","justification":""},{"idx":3,"correct":false,"proposition":"Methotrexate","justification":""},{"idx":4,"correct":true,"proposition":"Low molecular weight heparin at prophylactic dose","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-12-qi-14","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"Three days after starting treatment with antibiotics and heparin therapy at a prophylactic dose, pelvic pain persists, as does fever. The patient is still bloated. You request a CT scan with contrast injection. What is the most likely diagnosis?","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Textiloma"},{"idx":1,"correct":false,"proposition":"Urolithiasis enclosed in the lower right ureter","justification":""},{"idx":2,"correct":false,"proposition":"Acute appendicitis"},{"idx":3,"correct":true,"proposition":"Thrombosis of the right ovarian vein","justification":""},{"idx":4,"correct":false,"proposition":"Left pelvic abscess"}],"type":"dp"}
+{"_id":"annales-2019-dp-12-qi-15","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"In addition to the patient's personal and family thrombotic history, what additional risk factor(s) do you identify in this context of right ovarian vein thrombosis?","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Primiparity","justification":""},{"idx":1,"correct":false,"proposition":"The context of prematurity","justification":""},{"idx":2,"correct":true,"proposition":"The patient's body mass index","justification":""},{"idx":3,"correct":true,"proposition":"Caesarean section","justification":""},{"idx":4,"correct":true,"proposition":"Postpartum endometritis","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-12-qi-16","context":"A 36-year-old patient comes to consult urgently for moderate metrorrhagia and delayed menstruation of 2 weeks. She is 1m65 tall and weighs 89 kg. She is a smoker (25 packs year). She has a history of phlebitis of the lower right limb after orthopedic treatment for right ankle sprain. His mother developed a pulmonary embolism postpartum. His father died. He had bilateral hearing loss and had a kidney transplant. She provides contraception with condoms. She performed a urine pregnancy test which is positive.","enonce":"Knowing that serum creatinine is controlled at 70 micromol \/ L and that the patient wishes to continue breastfeeding, what is your anticoagulant prescription for this thrombophlebitis of the right ovarian vein ","item":"annales-2019-dp-12","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Fluindione","justification":""},{"idx":1,"correct":false,"proposition":"Acenochocoumarol","justification":""},{"idx":2,"correct":false,"proposition":"Warfarin","justification":""},{"idx":3,"correct":true,"proposition":"Enoxaparin at a hypocoagulant dose","justification":"LMWH then AVK relay"},{"idx":4,"correct":false,"proposition":"Cellar filter","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-14-qi-1","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"In view of the context, which diagnosis is to be mentioned in the first intention? ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Bladder lithiasis","justification":""},{"idx":1,"correct":true,"proposition":"Cystitis","justification":""},{"idx":2,"correct":false,"proposition":"Pyelonephritis","justification":""},{"idx":3,"correct":false,"proposition":"Renal tumour","justification":""},{"idx":4,"correct":false,"proposition":"Urothelial tumour","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-14-qi-2","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"What is (are) the element(s) to be collected during the interrogation in this context of discovery of hematuria? (one or more true propositions) ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"History of gross hematuria","justification":""},{"idx":1,"correct":true,"proposition":"Presence of proteinuria on the strip","justification":""},{"idx":2,"correct":false,"proposition":"Exposure to lead","justification":"No report"},{"idx":3,"correct":true,"proposition":"Family history of hematuria","justification":""},{"idx":4,"correct":false,"proposition":"Family history of bladder cancer","justification":"We do not start at all on a bladder cancer, which is not a hereditary pathology"}],"type":"dp"}
+{"_id":"annales-2019-dp-14-qi-3","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"The ECBU you prescribed to the patient currently finds: red blood cells 150,000\/ml; leukocytes< 1,000\/ml, sterile culture. There was a proteinuria with 2 crosses to the strip but the urine was concentrated. Her blood pressure is currently at 150\/90 mmHg in your consulting room. Her urinary beta-HCG is negative (the last menstrual period started 8 days ago). What biological examination(s) do you prescribe for this patient at this stage: (one or more expected proposals) ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Serum creatinine with glomerular filtration rate calculation","justification":""},{"idx":1,"correct":true,"proposition":"Proteinuria and creatinineuria on urine specimen","justification":""},{"idx":2,"correct":false,"proposition":"Crystalluria","justification":""},{"idx":3,"correct":false,"proposition":"Urinary cytology","justification":""},{"idx":4,"correct":false,"proposition":"Urinary pH","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-14-qi-4","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"What imaging test(s) do you prescribe for this patient at this stage? ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Uroscanner ","justification":""},{"idx":1,"correct":false,"proposition":"Endovaginal pelvic ultrasound","justification":""},{"idx":2,"correct":true,"proposition":"Renal and bladder ultrasound","justification":""},{"idx":2,"correct":false,"proposition":"uro-MRI","justification":""},{"idx":2,"correct":false,"proposition":"Retrograde cystography and voiding","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-14-qi-5","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"What is the action to take in the face of the discovery of this high blood pressure in this patient? (One or more correct answers) ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Prescription of amlodipine pending the results of biological tests","justification":""},{"idx":1,"correct":true,"proposition":"Request for outpatient self-measurement of blood pressure measurements","justification":""},{"idx":2,"correct":false,"proposition":"Prescription of an anxiolytic","justification":""},{"idx":3,"correct":false,"proposition":"Need to see the patient again within 48 hours for blood pressure control","justification":""},{"idx":4,"correct":true,"proposition":"Reassessment of blood pressure after discontinuation of ibuprofen","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-14-qi-6","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"The results of the prescribed examinations are as follows: Na 142 mmol\/L; K 4 mmol\/L, 2); proteinuria 2.5 g\/24 h, selective; serum creatinine 90 μmol\/L (DFG CKD-EPI at 71 mL\/min\/1.73 m^2 ECBU red blood cells 200,000\/mL, leukocytes< 1,000\/ml. Renal ultrasound finds kidneys of 118 mm and 122 mm respectively on the right and left with a cyst of the upper right pole of 1 cm. They are well differentiated, the cortical thickness is 22 mm, homogeneous. His ambulatory blood pressure is 150\/90 mmHg on average despite stopping ibuprofen. She describes asthenia and a recent loss of her hair that she links to strong tensions at work. You refer the patient to a nephrologist with other laboratory tests. Which examination(s) is the most relevant exam(s) given the context in this patient?","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"NFS, platelets","justification":""},{"idx":1,"correct":true,"proposition":"Plasma protein immunoelectrophoresis","justification":""},{"idx":2,"correct":false,"proposition":"Determination of parathyroid hormone and 250H vitamin D","justification":""},{"idx":3,"correct":true,"proposition":"Anti-nuclear factors, anti-DNA antibodies","justification":""},{"idx":4,"correct":true,"proposition":"Dosage C3, C4, CH50","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-14-qi-7","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"Your additional assessment is as follows: leukocytes 3.50 G \/ L, Hb 9 g \/ dL, VGM 92 fi; e platelets 200 G\/L, reticulocytes 250 G\/L, anti-nuclear factors positive at 1\/160 with native anti-DNA antibodies at 40 Ul\/ml, C3 0.5 g\/L (0.8-1.6); C4 0.08 g\/L (0.17-0.53), CH50 40 50 CRP 7 mg\/L; HCV and HIV negative serologies; HBV serology: anti-HBs 100 Ul\/ml antibodies, negative anti-HBc antibodies. What is (are) in favor of a diagnosis of systemic lupus? ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Leukopenia","justification":""},{"idx":1,"correct":true,"proposition":"Consumption of the supplement","justification":""},{"idx":2,"correct":true,"proposition":"Regenerative anemia","justification":""},{"idx":3,"correct":false,"proposition":"Inflammatory syndrome","justification":""},{"idx":4,"correct":true,"proposition":"Microscopic hematuria","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-14-qi-8","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"What are the possible causes of this anemia in this context (one or more correct answers)? ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Chronic renal failure","justification":""},{"idx":1,"correct":false,"proposition":"Immunological thrombocytopenic purpura","justification":""},{"idx":2,"correct":true,"proposition":"Coombs-positive hemolytic anemia","justification":""},{"idx":3,"correct":false,"proposition":"Thrombotic microangiopathy","justification":""},{"idx":4,"correct":true,"proposition":"Acute gynecological bleeding","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-14-qi-9","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"What extrarenal clinical signs will you look for in the context of this probable lupus flare-up? (One or more correct answers) ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Mouth ulcers","justification":""},{"idx":1,"correct":true,"proposition":"Erythema nodosum","justification":""},{"idx":2,"correct":true,"proposition":"Polyarthritis","justification":""},{"idx":3,"correct":false,"proposition":"Scleroditactyly","justification":""},{"idx":4,"correct":true,"proposition":"Vulvar ulcerations","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-14-qi-10","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"The patient has non-erosive mouth ulcers and arthritis of the hands and you are diagnosed with systemic lupus. What is the most appropriate course of action for this patient at this stage? (Only one response is expected.) ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Biological monitoring as a first step","justification":""},{"idx":1,"correct":true,"proposition":"Performing a transparietal renal biopsy puncture","justification":""},{"idx":2,"correct":false,"proposition":"Realization of a uroscanner","justification":""},{"idx":3,"correct":false,"proposition":"Performing a renal angiography","justification":""},{"idx":4,"correct":false,"proposition":"No need for renal histological confirmation in this context of leupic nephropathy","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-14-qi-11","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"You decide to perform a kidney biopsy on this patient. She is hospitalized in nephrology. His clinical examination regained a blood pressure of 155\/90 mmHg. She is apyretic but has had voiding burns for 48 hours. Its biological balance finds: leukocytes 3.8 G \/ L, Hb 9.4 g \/ dL, VGM 88 fL, platelets 220 G \/ L, Na 142 mmol \/ L, K 3.7 mmol \/ L; 2 ); serum creatinine 99 μmol\/L (glomerular filtration rate CKD-EPI at 63 ml\/min\/1.73 m^2 proteinuria 2.2 g\/24 h, selective; ECBU red blood cells 300,000\/ml; leukocytes 20,000\/ml; many live Gram-negative bacilli. You decide to treat 48 hours this probable cystitis before performing the renal biopsy puncture and normalizing his blood pressure. What are the elements of your therapeutic care? (One or more correct answers) ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Treatment with metronidazole","justification":""},{"idx":1,"correct":false,"proposition":"Treatment with single-dose ofloxacin","justification":""},{"idx":2,"correct":false,"proposition":"Amoxicillin treatment","justification":""},{"idx":3,"correct":true,"proposition":"Treatment with fosfomycin-trometamol","justification":""},{"idx":4,"correct":false,"proposition":"Treatment with gentamicin","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-14-qi-12","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"What are the possible basic histological elements in this patient given her clinicobiological presentation? (One or more correct answers) ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Dominant mesangial deposits of immunoglobulin A and complement","justification":""},{"idx":1,"correct":true,"proposition":"Extra-capillary proliferation","justification":""},{"idx":2,"correct":true,"proposition":"Endocapillary proliferation","justification":""},{"idx":3,"correct":true,"proposition":"Extramembranous immunoglobulin and complement deposits in immunofluorescence","justification":""},{"idx":4,"correct":false,"proposition":"Glomerular deposits of dominant C3","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-14-qi-13","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"Here is the report of your patient's renal biopsy: 8 mm renal cortical fragment containing 15 glomeruli including 1 sealing loaf; Optical microscopy: 10 glomeruli out of 15 are the site of endocapillary proliferation, presence of extra-capillary proliferations on 3 glomeruli, voluminous endomembranous deposits along the glomerular capillaries making << wireloops >>; - polymorphic interstitial infiltrate on about 30% of the cortical surface; - no vascular lesions or tubular lesions, presence of haematic cylinders in some tubular lumen; - immunofluorescence:  granular deposits of Ig G, lgM, C3 and C1q to 3+ mesangial and 2+ endomembranous on all glomeruli, no extramembranous deposits, fibrin deposits on 4 out of 18 glomeruli. What is your diagnosis?","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Extramembranous lupus glomerulonephritis","justification":""},{"idx":1,"correct":false,"proposition":"Pure mesangial lupus glomerulonephritis","justification":""},{"idx":2,"correct":true,"proposition":"Diffuse proliferative lupus glomerulonephritis","justification":""},{"idx":3,"correct":false,"proposition":"Tubulointerstitial lupus nephritis","justification":""},{"idx":4,"correct":false,"proposition":"Focal proliferative lupus glomerulonephritis","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-14-qi-14","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"Your patient therefore has a systemic lupus flare-up with hemolytic anemia, polyarthritis, canker sores, alopecia and class IV lupus glomerulonephritis (diffuse proliferative). What are the treatment options for attack therapy in this patient? (One or more correct answers) ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"A course of infliximab","justification":"It's an alpha anti-TNF, nothing to see"},{"idx":1,"correct":false,"proposition":"A course of rituximab","justification":"It's an anti-CD20, nothing to see"},{"idx":2,"correct":true,"proposition":"bolus of methylprednisolone then prednisone 1 mg\/kg","justification":""},{"idx":3,"correct":true,"proposition":"mycophenolate mofetil","justification":""},{"idx":4,"correct":true,"proposition":"cyclophosphamide","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-14-qi-15","context":"A 36-year-old Caucasian patient is referred to her general practitioner for the discovery of a three-cross hematuria on the urine strip in occupational medicine, with a blood pressure of 155\/90 mmHg. The patient's main history is an appendectomy and frequent cystitis (3 to 4 per year, the last 3 months ago treated with fluoroquinolones). She had 2 pregnancies and 2 vaginal deliveries at age 25 and 30 (the last pregnancy complicated by pre-eclampsia). She currently wears an IUD. She has a smoking rate of 10 packs\/year unweaned. She does not take any long-term treatment except ibuprofen occasionally for menstrual pain in particular. It weighs 60 kg for 1.68 m. She works in finance in a position of high responsibility and is under great stress.","enonce":"You start the attack treatment which is well tolerated including corticosteroid therapy in high doses. His blood pressure is 145\/90 mmHg on ramipril that you started before the kidney biopsy. His renal assessment before discharge is as follows: serum creatinine 97 μmol \/ L (filtration rate 2 glomerular CKD-EPI at 65 ml \/ min \/ 1.73 m ^ 2 ), proteinuria 2.2 g \/ 24 h; ECBU red blood cells 350000\/ml. What are the different possible therapeutic measures before returning home? (one or more correct answers) ","item":"annales-2019-dp-14","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Amlodipine in combination with ramipril","justification":""},{"idx":1,"correct":true,"proposition":"Hydroxychloroquine","justification":""},{"idx":2,"correct":true,"proposition":"Cholecalciferol","justification":""},{"idx":3,"correct":true,"proposition":"Hydrochlorothiazide in combination with ramipril","justification":""},{"idx":4,"correct":false,"proposition":"Candesartan in combination with ramipril","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-15-qi-1","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"What are you looking for in interrogation to explore this anomaly? (One or more correct answers)","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Recent extended stay at altitude","justification":""},{"idx":1,"correct":true,"proposition":"Tobacco use"},{"idx":2,"correct":true,"proposition":"Alcohol consumption"},{"idx":3,"correct":true,"proposition":"Recent fever"},{"idx":4,"correct":true,"proposition":"Recent weight gain"}],"type":"dp"}
+{"_id":"annales-2019-dp-15-qi-2","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"On clinical examination, what signs would point you to primary polycythemia? (one or more possible answers) ","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Palar erythrosis","justification":""},{"idx":1,"correct":true,"proposition":"Aquagenic pruritus","justification":""},{"idx":2,"correct":false,"proposition":"Conjunctival hyperemia","justification":""},{"idx":3,"correct":false,"proposition":"Exertional dyspnea","justification":""},{"idx":4,"correct":false,"proposition":"Splenomegaly","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-15-qi-3","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"You make a blood count that shows: GR 6.9 T\/L; haemoglobin 18.7 g\/dL, haematocrit 57%; MCV 83 fL, MCHC 33 g\/dL, reticulocytes 80 G\/L, leukocytes 12.6 G\/L, neutrophils 10.4 G\/L, eosinophil polynuclear 0.3 G\/L, basophilic polynuclear 0.05 G\/L, lymphocytes 1.25 G\/L, monocytes 0.6 G\/L, platelets 534 G\/L. What does this blood count show? (one or more possible answers)","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Polycythemia","justification":""},{"idx":1,"correct":false,"proposition":"Hyperreticulocytosis","justification":""},{"idx":2,"correct":false,"proposition":"Hyperchromia","justification":""},{"idx":3,"correct":false,"proposition":"Microcytosis","justification":""},{"idx":4,"correct":true,"proposition":"Thrombocytosis","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-15-qi-4","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"You find on examination a splenomegaly with a costal overhang of 2 cm and the notion of aquagenic pruritus. Which of the following tests are useful in this patient to support the diagnosis of polycythemia vera (one or more answers are possible)?","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Erythropoietin Dosage","justification":""},{"idx":1,"correct":false,"proposition":"Myelogram","justification":""},{"idx":2,"correct":true,"proposition":"JAK2 mutation search","justification":""},{"idx":3,"correct":false,"proposition":"Culture of erythroid progenitors","justification":""},{"idx":4,"correct":false,"proposition":"Isotopic globular mass","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-15-qi-5","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"You see the patient again with the results of your tests. He has a JAK2 mutation and erythropoietin levels are plummeted. The patient, worried, asks you about complications that may occur. What do you say to him (One or more possible answers here)?","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Venous thrombosis","justification":""},{"idx":1,"correct":true,"proposition":"Arterial thrombosis","justification":""},{"idx":2,"correct":false,"proposition":"Lysis syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Disseminated intravascular coagulation","justification":""},{"idx":4,"correct":true,"proposition":"Gout attack","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-15-qi-6","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"About polycythemia vera, which propositions are true? (One or more possible answers)","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"It is a clonal disease of mature hematopoietic cells","justification":""},{"idx":1,"correct":true,"proposition":"This is a myeloproliferative syndrome","justification":""},{"idx":2,"correct":false,"proposition":"There is an erythroblastic maturation blockade","justification":""},{"idx":3,"correct":false,"proposition":"Circulating erythroblasts are observed","justification":""},{"idx":4,"correct":true,"proposition":"There is spontaneous growth of erythroblastic progenitors in vitro","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-15-qi-7","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"The patient asks you about the principles of treatment. What kind of care do you discuss with him? (One or more correct answers) ","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":" Bleedings","justification":""},{"idx":1,"correct":true,"proposition":"Acetyl-salicylic acid","justification":""},{"idx":2,"correct":false,"proposition":"Anticoagulants","justification":""},{"idx":3,"correct":false,"proposition":"Mdt","justification":""},{"idx":4,"correct":false,"proposition":"Repeated blood donations at EFS","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-15-qi-8","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"The patient had initial bleeding and is currently on antiaggregants. Three months later, your patient comes to see you 48 hours after returning from vacation in the West Indies. He has a painful left calf that has been swollen for 24 hours. What clinical elements will support your suspicion of deep vein thrombosis (phlebitis)? (One or more possible answers) ","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Calf pressure pain","justification":""},{"idx":1,"correct":true,"proposition":"Increased calf circumference","justification":""},{"idx":2,"correct":false,"proposition":"Calf contracture","justification":""},{"idx":3,"correct":false,"proposition":"Decreased pediosus pulse","justification":""},{"idx":4,"correct":true,"proposition":"Dilation of superficial veins","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-15-qi-9","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"What are the risk factors for phlebitis in this patient? (One or more correct answers)","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Obesity","justification":""},{"idx":1,"correct":false,"proposition":"Long-term antiplatelet agent","justification":""},{"idx":2,"correct":false,"proposition":"High blood pressure (hypertension)","justification":""},{"idx":3,"correct":false,"proposition":"Hypercholesterolemia","justification":""},{"idx":4,"correct":true,"proposition":"Air travel","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-15-qi-10","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"The clinical examination is not very specific. Which tests are useful for diagnosis? (One or more possible answers)","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Pulmonary angiography","justification":""},{"idx":1,"correct":true,"proposition":"Doppler ultrasound of the lower limbs","justification":""},{"idx":2,"correct":false,"proposition":"Phlebography of the lower limbs","justification":""},{"idx":3,"correct":false,"proposition":"TP, TCA, fibrin","justification":""},{"idx":4,"correct":false,"proposition":"Search for protein C and S deficiency","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-15-qi-11","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"Doppler ultrasound confirmed the existence of sural phlebitis. What therapeutic attitudes are possible in this patient? (One or more possible answers) ","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Direct oral anticoagulants","justification":""},{"idx":1,"correct":false,"proposition":"Acetylsalicylic acid and clopidogrel","justification":""},{"idx":2,"correct":true,"proposition":"Low molecular weight heparin","justification":""},{"idx":3,"correct":false,"proposition":"Strict bed rest","justification":""},{"idx":4,"correct":true,"proposition":"Venous compression","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-15-qi-12","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"You have opted for LMWH treatment with early relay with vitamin K antagonist (warfarin). What recommendations do you give your patient in relation to this treatment? (one or more possible answers) ","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Wearing a card mentioning the treatment on oneself","justification":""},{"idx":1,"correct":true,"proposition":"Taking warfarin at a fixed time","justification":""},{"idx":2,"correct":false,"proposition":"Follow a strict diet","justification":"This is not a strict diet: just avoid a few foods that interfere with hepatic enzyme metabolism."},{"idx":3,"correct":false,"proposition":"Strict cessation of alcohol consumption","justification":""},{"idx":4,"correct":true,"proposition":"Prohibition of intramuscular injections","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-15-qi-13","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"During his follow-up, the patient calls you because his control INR is 5.5. He found no bleeding signs. What do you do? ","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"You hospitalize him","justification":""},{"idx":1,"correct":true,"proposition":"You ask him to skip a catch","justification":""},{"idx":2,"correct":false,"proposition":"You prescribe vitamin K orally","justification":""},{"idx":3,"correct":false,"proposition":"You prescribe protamine sulfate","justification":""},{"idx":4,"correct":true,"proposition":"You recheck the INR the next day","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-15-qi-14","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"Your patient has been transferred to a city 500 km from your home. You have no news for several years. Then, a doctor who sees him for the first time calls you because the patient is referred to him for discomfort. The blood count shows: Hb 10 g\/dL, MCV 83 fL, leukocytes 3 G\/L, PNN 0.8 G\/L, lymphocytes 1 G\/L, monocytes 0.2 G\/L, blast cells 1 G\/L, platelets 86 G\/L. What abnormalities do you see on this blood count? (One or more correct answers) ","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Neutropenia","justification":""},{"idx":1,"correct":true,"proposition":"Thrombocytopenia","justification":""},{"idx":2,"correct":false,"proposition":"Balanced myelemia","justification":""},{"idx":3,"correct":true,"proposition":"Pancytopenia","justification":""},{"idx":4,"correct":false,"proposition":"Microcytic anemia","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-15-qi-15","context":"Mr. M, 45 years old, SNCF controller, comes to see you for \"increase of red blood cells\". He is an occasional blood donor and was rejected because of too high a hemoglobin. He does not know the results of the blood count. He is 1.72m tall and weighs 93 kg (BMI = 31) with facial erythrosis, but says he has always looked \"good\". He has been taking amlodipine for hypertension for 5 years, and pravastatin for hypercholesterolemia.","enonce":"What diagnoses do you mention in this context? (One or more possible answers) ","item":"annales-2019-dp-15","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Transformation into acute leukemia","justification":""},{"idx":1,"correct":false,"proposition":"Progression to myelofibrosis","justification":""},{"idx":2,"correct":false,"proposition":"Syndrome de Richter","justification":""},{"idx":3,"correct":false,"proposition":"Transformation into chronic myelogenous leukemia","justification":""},{"idx":4,"correct":false,"proposition":"Progression to myeloid splenomegaly","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-16-qi-1","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"The nurse on the unit gives you the following information: blood pressure at 95\/55mmHg, temperature at 39°C and heart rate at 110\/min. Dyspnea is in the foreground. On pulmonary auscultation, you find a decrease in the vesicular murmur of the base of the left lung. Which of the following proposals is (are) the element(s) in favor of pleural effusion in this patient?","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Noise added to left one-sided crackling type","justification":""},{"idx":1,"correct":true,"proposition":"Dull percussion at the left base","justification":""},{"idx":2,"correct":false,"proposition":"Increased vocal vibration","justification":""},{"idx":3,"correct":false,"proposition":"Noise added to expiratory sibilant type","justification":""},{"idx":4,"correct":false,"proposition":"Chest distension","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-16-qi-2","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"You get more information for this patient who lives alone at home independently. He has a history of NYHA stage III heart failure on ischemic and hypertensive heart disease. The nurse had her daughter on the phone telling her that her father has not been elected as usual for 48 hours, with incoherent words. \nAt careful pulmonary auscultation, you find noises added to type of unilateral crackles in the left base. Vocal vibrations are increased in the left base. He has no signs of right heart failure. \nWhich of the following is the most likely etiology(s) of the pulmonary picture? (one or more exact propositions)","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Acute pericarditis"},{"idx":1,"correct":false,"proposition":"Pulmonary embolism"},{"idx":2,"correct":true,"proposition":"Community-acquired bacterial pneumonia","justification":""},{"idx":3,"correct":false,"proposition":"Pneumothorax"},{"idx":4,"correct":true,"proposition":"Community-acquired viral pneumonia","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-16-qi-3","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"To assess the seriousness of this patient, which element seems most important?","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Looking for a sign of neurological focus","justification":""},{"idx":1,"correct":false,"proposition":"Purpura search","justification":""},{"idx":2,"correct":true,"proposition":"Respiratory rate measurement","justification":""},{"idx":3,"correct":false,"proposition":"Diuresis measurement","justification":""},{"idx":4,"correct":false,"proposition":"Search for a paradoxical pulse","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-16-qi-4","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"The patient has a respiratory rate of 35\/min and his saturation is measured at 94% in ambient air. You suspect acute lobar pneumonia. Which of the following additional examinations should be carried out immediately? (one or more exact propositions)","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Blood gas","justification":""},{"idx":1,"correct":true,"proposition":"ECG","justification":""},{"idx":2,"correct":false,"proposition":"D-Dimers","justification":""},{"idx":3,"correct":true,"proposition":"X-ray of the front chest","justification":""},{"idx":4,"correct":true,"proposition":"Blood","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-16-qi-5","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"Biological samples are in progress and chest X-ray shows alveolar opacity of the left base associated with low pleural effusion. Arterial blood gases show: PaO 62 mmHg; PaCO 28 mmHg; lactate 1.3 mmol\/L; pH 7.46. Which of the following propositions in this patient is(s) the correct statement(s)? ","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"You immediately think of a pulmonary embolism","justification":""},{"idx":1,"correct":false,"proposition":"You think it's consistent with the diagnosis of pneumonia","justification":""},{"idx":2,"correct":false,"proposition":"You think the value of lactate points to acute community-acquired pneumonia","justification":""},{"idx":3,"correct":false,"proposition":"You think pleural effusion may explain the gasometric shunt effect","justification":""},{"idx":4,"correct":false,"proposition":"You suspect a sampling error","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-16-qi-6","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"Given the context of falling, you examine the musculoskeletal system. Your exam finds pain in your right hip. You suspect a fracture of the right femoral neck because there are: (one or more possible answers) ","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Functional impotence of the right lower limb","justification":""},{"idx":1,"correct":true,"proposition":"Pain on palpation of the right great trochanter","justification":""},{"idx":2,"correct":false,"proposition":"Internal rotation of the right hip","justification":""},{"idx":3,"correct":false,"proposition":"A psoitis on the right side","justification":""},{"idx":4,"correct":false,"proposition":"Shortening of the lower right limb","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-16-qi-7","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"The hip X-ray does not show a fracture of the femoral neck. The blood count shows leukocytes at 15 G\/L, hemoglobin at 10 g\/dL and platelets at 349 G\/L. The serum creatinine is 75 micromol\/L. What care do you start with this patient? ","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Nasal oxygen","justification":""},{"idx":1,"correct":true,"proposition":"Peripheral venous route","justification":""},{"idx":2,"correct":false,"proposition":"Intravenous ciprofloxacin","justification":""},{"idx":3,"correct":true,"proposition":"Low molecular weight heparin at preventive dose","justification":""},{"idx":4,"correct":false,"proposition":"Isotonic saline in venous infusion 3 liters \/ day","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-16-qi-8","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"Which of the following other measures is the most important to put in place? ","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Prevention of swallowing disorders","justification":""},{"idx":1,"correct":false,"proposition":"Prevention of dehydration","justification":""},{"idx":2,"correct":true,"proposition":"Pressure ulcer prevention","justification":"It is an early complication and carries great morbidity"},{"idx":3,"correct":false,"proposition":"Urinary catheter placement","justification":""},{"idx":4,"correct":false,"proposition":"Oral care","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-16-qi-9","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"During the first 24 hours of hospitalization, the patient has incoherent words. He believes he is in 1939. At times, on the contrary, it seems well suited. It is most often drowsy. When you enter the room, he does not remember seeing you in the morning and does not know that he is hospitalized. You mention a delirium syndrome. Which semiological element(s) present in the observation is (are) in favor of this diagnostic hypothesis? ","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Attentional disorders","justification":""},{"idx":1,"correct":true,"proposition":"Fluctuations in unrest","justification":""},{"idx":2,"correct":false,"proposition":"Phasia disorders","justification":""},{"idx":3,"correct":false,"proposition":"Memory disorder","justification":""},{"idx":4,"correct":false,"proposition":"Apathy","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-16-qi-10","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"The patient was put on oxygen and antibiotic therapy was started. The next morning the nurse finds that the patient is getting worse. What sign(s) would be in favor of hypercapnia? ","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"The presence of low blood pressure","justification":""},{"idx":1,"correct":false,"proposition":"The presence of ample dyspnea","justification":""},{"idx":2,"correct":true,"proposition":"Deepening confusion","justification":""},{"idx":3,"correct":true,"proposition":"The presence of sweat","justification":""},{"idx":4,"correct":true,"proposition":"An asterixis","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-16-qi-11","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"Finally, the patient evolves favorably on the respiratory plan in your 3 days with apyrexia and a reduction in respiratory rate. However, he has not eaten anything in the last 3 days and you fear the presence of protein-energy malnutrition (MPE). Which of the following proposals regarding its nutritional status is the right proposal(s)?","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"His nutritional status may not have deteriorated sufficiently in 3 days","justification":""},{"idx":1,"correct":false,"proposition":"The determination of blood albumin is essential to determine the nutritional status","justification":""},{"idx":2,"correct":false,"proposition":"Lack of power over the last 3 days can define an MPE","justification":""},{"idx":3,"correct":false,"proposition":"MPE can be defined according to HAS by weight loss over the past year","justification":""},{"idx":4,"correct":true,"proposition":"A body mass index < 21 kg\/m^2 defines MPE","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-16-qi-12","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"On the 4th day, your patient can get up but the bipodal support is painful preventing walking and the unipodal support on the right is impossible. A second hip X-ray is re-read normally. \nWhich of the following proposals regarding his condition is(s) the correct statement(s) at this stage? (one or more exact propositions)","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"You prescribe a bone scan","justification":""},{"idx":1,"correct":false,"proposition":"You suspect a simple bruise","justification":""},{"idx":2,"correct":true,"proposition":"You are looking for an ilio- or ischiopubic branch fracture","justification":""},{"idx":3,"correct":true,"proposition":"You prescribe a scanograhie of the pelvis and hips","justification":""},{"idx":4,"correct":false,"proposition":"You prescribe an X-ray of the right knee","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-16-qi-13","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"The CT scan revealed a fracture of the right iliopubic branch. The evolution is favorable under analgesic treatment and active early mobilization in one week. You plan to return home. What element(s) should be assessed before considering a return home?","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"ADL","justification":""},{"idx":1,"correct":true,"proposition":"IADL","justification":""},{"idx":2,"correct":false,"proposition":"MNA","justification":""},{"idx":3,"correct":true,"proposition":"Fried's criteria","justification":""},{"idx":4,"correct":false,"proposition":"Geriatric depression scale","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-16-qi-14","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"You have assessed their basic activities of daily living (ADL score). What element(s) constitutes this score? ","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"His ability to shop without help","justification":""},{"idx":1,"correct":false,"proposition":"Its ability to answer the phone without aids","justification":""},{"idx":2,"correct":false,"proposition":"Its ability to use public transport without aids","justification":""},{"idx":3,"correct":true,"proposition":"Its ability to eat without aids","justification":""},{"idx":4,"correct":false,"proposition":"Their ability to manage medications without aids","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-16-qi-15","context":"You welcome an 84-year-old patient directly into the geriatric ward following a fall. The patient complains of dyspnea. You do not currently have any information about his background.","enonce":"You measure their current ADL (Basic Activities of Daily Living) score at 4\/6, and their iso-resource group (GIR) at 4. What is the correct interpretation(s)?","item":"annales-2019-dp-16","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"The ADL score shows that there is an addiction for one's instrumental activities of daily living","justification":""},{"idx":1,"correct":false,"proposition":"The GIR is associated with the ADL level","justification":"At the AGGIR grid"},{"idx":2,"correct":true,"proposition":"The ADL score does not measure the presence of a cognitive disorder","justification":""},{"idx":3,"correct":true,"proposition":"Cognitive impairment is taken into account in the measurement of the GIR","justification":""},{"idx":4,"correct":true,"proposition":"It seems likely that he will obtain financial assistance for his home helpers","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-17-qi-1","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"What semeiological element(s) are you looking for in favor of a cardiac cause of dyspnea in this patient? ","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Morning cough and sputum","justification":""},{"idx":1,"correct":false,"proposition":"Digital Hippocratism","justification":""},{"idx":2,"correct":false,"proposition":"Cough during exertion and decubitus","justification":""},{"idx":3,"correct":false,"proposition":"Gravity of the hypochondrium right to effort","justification":""},{"idx":4,"correct":false,"proposition":"Palpitations at the effrt","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-17-qi-2","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"The patient lives on the 38th floor with elevator. He does not present respiratory discomfort for everyday gestures. On the other hand, it signals dyspnea when walking uphill at normal speed (4 km \/ h). \nAt what stage of the NYHA does this description fit?","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"I"},{"idx":1,"correct":true,"proposition":"II"},{"idx":2,"correct":false,"proposition":"III"},{"idx":3,"correct":false,"proposition":"IV"},{"idx":4,"correct":false,"proposition":"Unclassifiable with available data","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-17-qi-3","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"The patient has NYHA stage II dyspnea. Cardiac auscultation reveals mitral insufficiency. On which auscultatory anomaly(ies) is this diagnosis based?","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Protodiastolic murmur","justification":""},{"idx":1,"correct":false,"proposition":"Mesosystolic strengthening breath","justification":""},{"idx":2,"correct":true,"proposition":"Holosystolic murmur","justification":""},{"idx":3,"correct":false,"proposition":"Raspy tone","justification":""},{"idx":4,"correct":false,"proposition":"Abolition of B1","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-17-qi-4","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"The general practitioner refers the patient to a cardiology consultation. While waiting for his appointment, the patient is admitted to the emergency room for acute dyspnea. The emergency physician evokes an acute edema of the lung (OAP) cardigenic. What is the main semeiological argument for this diagnosis?","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"oxygen desaturation (SpO2)"},{"idx":1,"correct":false,"proposition":"focus of crackling rales"},{"idx":2,"correct":true,"proposition":"Complete intolerance to supine position"},{"idx":3,"correct":false,"proposition":"chest tightness"},{"idx":4,"correct":false,"proposition":"jugular turgor","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-17-qi-5","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"The clinical examination finds bilateral crackling rales going back to mid-field. Routine laboratory tests (blood count, platelets, blood ionogram, urea and serum creatinine) have been taken and you are waiting for the results. What is (are) the additional examination(s) essential before starting treatment? ","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Electrocardiogram","justification":""},{"idx":1,"correct":false,"proposition":"Determination of BNP or NT-proBNP","justification":""},{"idx":2,"correct":false,"proposition":"Determination of D-dimer","justification":""},{"idx":3,"correct":false,"proposition":"Pulmonary angio-CT","justification":""},{"idx":4,"correct":false,"proposition":"Echocardiography","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-17-qi-6","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"A chest X-ray is performed. What abnormality(s) present on this picture is (are) in favor of the diagnosis of heart failure?","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Cardiomegaly"},{"idx":1,"correct":true,"proposition":"Right pleural effusion"},{"idx":2,"correct":false,"proposition":"Vascular redistribution at the bases","justification":""},{"idx":3,"correct":true,"proposition":"Kerley Lines"},{"idx":4,"correct":false,"proposition":"Pericardial effusion"}],"type":"dp"}
+{"_id":"annales-2019-dp-17-qi-7","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"The electrocardiogram does not show an argument in favor of an acute coronary syndrome. The presence of orthopnea, diffuse subcrackling rales halfway up the pulmonary fields with bilateral radiological alveolar syndrome was sufficient for the diagnosis of acute pulmonary edema. Blood pressure is at 140\/90 mmHg, heart rate is at 110 beats\/min, there is no mottling or cooling of the extremities. Treatment with furosemide and oxygen therapy are started. Which complementary treatment(s) should be prescribed urgently? ","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Nitrates by intravenous infusion with an electric syringe","justification":""},{"idx":1,"correct":false,"proposition":"Dobutamine intravenous infusion with an electric syringe","justification":""},{"idx":2,"correct":false,"proposition":"Bisoprolol orally in small doses","justification":""},{"idx":3,"correct":false,"proposition":"Unfractionated intravenous heparin for 2.5x control ACT","justification":""},{"idx":4,"correct":false,"proposition":"Isotonic salted serum infusion 1 Uj","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-17-qi-8","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"The response to treatment is quickly favorable. An electrocardiogram is recorded again. What is the interpretation of this electrocardiogram?","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Normal electrocardiogram"},{"idx":1,"correct":true,"proposition":"Sequelae of myocardial infarction","justification":""},{"idx":2,"correct":false,"proposition":"Full right branch block","justification":""},{"idx":3,"correct":true,"proposition":"Sinus rhythm"},{"idx":4,"correct":false,"proposition":"Left posterior hemibloc (fascicular block)","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-17-qi-9","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"An echocardiogram is performed with the following results: - dilation of the left ventricle with alteration of the ejection fraction to 30%; - Akinesia of the lower wall with hypokinesia of the lateral wall of the left ventricle; - dilation of the left atrium and right ventricle; - elevation of the filling pressures of the left ventricle; - moderate mitral leakage (grade II) of restrictive mechanism associated with dilation of the mitral ring. Systolic pulmonary arterial pressure is estimated to be elevated. What is (are) the contribution(s) of this echocardiography concerning the diagnosis?","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Mitral insufficiency is ischemic","justification":""},{"idx":1,"correct":true,"proposition":"The patient presented with an unnoticed myocardial infarction","justification":""},{"idx":2,"correct":true,"proposition":"The current picture of heart failure is due to ischemic heart disease","justification":""},{"idx":3,"correct":false,"proposition":"The current picture of heart failure is valvular cause","justification":""},{"idx":4,"correct":false,"proposition":"The patient developed pulmonary embolism","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-17-qi-10","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"It is an ischemic heart disease with mitral leakage secondary to an unnoticed inferior myocardial infarction, complicated by heart failure with impaired ejection fraction. Which of the following decisions is, at this stage, the most important for this patient? ","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Confirmation of pulmonary hypertension by right catheterization","justification":""},{"idx":1,"correct":true,"proposition":"Search for viability and myocardial ischemia of the left ventricle","justification":""},{"idx":2,"correct":false,"proposition":"Analysis of the possibility of mitral plasty surgery","justification":""},{"idx":3,"correct":false,"proposition":"Pre-heart transplant assessment","justification":""},{"idx":4,"correct":false,"proposition":"Metabolic stress test (with gas analysis and V02 calculation)","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-17-qi-11","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"The search for myocardial ischemia is positive in the anteroseptal territory and leads to the realization of a coronary angiography. This examination reveals critical stenosis of the anterior interventricular coronary artery that is treated by angioplasty (percutaneous coronary intervention) and placement of a stent (stent). \nWhat is (are) the therapeutic adaptation(s) to be made before returning home?","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Introduce a bradycardial calcium channel blocker (diltiazem or verapamil)","justification":""},{"idx":1,"correct":false,"proposition":"Initiate triple antithrombotic therapy (e.g. aspirin+apixaban+clopidogrel)","justification":""},{"idx":2,"correct":false,"proposition":"Combine ezetimibe with rosuvastatin","justification":""},{"idx":3,"correct":true,"proposition":"Introduce a beta oral blocker in progressive doses","justification":""},{"idx":4,"correct":true,"proposition":"Prescribe cardiac rehabilitation","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-17-qi-12","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"The patient discharges the hospital with carvedilol, enalapril, aspirin, prasugrel, rosuvastatin, furosemide, potassium salts and metformin. It is reviewed periodically to gradually increase the doses of carvedilol and enalapril to the target doses. Four months after revascularization, he is still dyspneic on exertion at NYHA stage II. He describes a first episode of brief loss of consciousness when climbing stairs, 30 minutes after taking his treatment. The search for orthostatic arterial hypotension is negative. The electrocardiogram is not changed. Echocardiography shows the persistence of systolic dysfunction with a stationary left ventricle ejection fraction at 30%, mitral leakage has not evolved and remains moderate (grade II). What is (are) the therapeutic adaptation(s) to be made to manage heart failure and its consequences? ","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Introduce a mineralocorticoid receptor antagonist","justification":""},{"idx":1,"correct":false,"proposition":"Implant a defibrillator","justification":""},{"idx":2,"correct":false,"proposition":"Reduce the dosages of enalapril and carvedilol","justification":""},{"idx":3,"correct":false,"proposition":"Implement ventricular resynchronization by biventricular stimulator","justification":""},{"idx":4,"correct":false,"proposition":"Prohibit excessive alcohol consumption","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-17-qi-13","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"A few months later the patient presents a brutal, intense pain in the lower right limb which wakes him up at 6 am. He consults you at noon. The pain is intolerable agitating the patient, the foot is livid and cold with functional impotence. You will only find the femoral pulse in the right lower limb. You observe a discrete bilateral perimalleolar edema, taking the bucket. Skin sensitivity is decreased on the right side of the knee to the foot. Palpation of the calf is painful. What is the diagnosis to evoke in this patient? ","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Gout attack","justification":""},{"idx":1,"correct":false,"proposition":"Deep vein thrombosis of the lower limb","justification":""},{"idx":2,"correct":false,"proposition":"Paralyzing sciatica","justification":""},{"idx":3,"correct":false,"proposition":"Cholesterol crystal embolism","justification":""},{"idx":4,"correct":true,"proposition":"Acute ischemia of the lower limb","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-17-qi-14","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"In front of this brutal clinical picture you retain the occurrence of acute limb ischemia. What is (are) the sign(s) of gravity?","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"The presence of edema"},{"idx":1,"correct":true,"proposition":"The presence of a sensory and motor deficit","justification":""},{"idx":2,"correct":true,"proposition":"Pain at the pressure of muscle masses","justification":""},{"idx":3,"correct":true,"proposition":"A long delay in handling","justification":""},{"idx":4,"correct":true,"proposition":"The level of arterial obstruction","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-17-qi-15","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"What additional diagnostic examination do you propose to this patient before entrusting him to the surgical team? ","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"No further examination","justification":""},{"idx":1,"correct":false,"proposition":"CT angiography (CT scan)","justification":""},{"idx":2,"correct":false,"proposition":"Arteriography","justification":""},{"idx":3,"correct":false,"proposition":"MRI angiography","justification":""},{"idx":4,"correct":false,"proposition":"Ultrasound-Doppler","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-17-qi-16","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"The surgical team will immediately take care of the patient to perform emergency revascularization. What is (are) the modality(s) of care to be put in place immediately?","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Lower limb elevation","justification":"This will further decrease the arterial influx. On the contrary, they must be put in the unslid position."},{"idx":1,"correct":true,"proposition":"Unfractionated heparin with an electric syringe after an intravenous bolus","justification":""},{"idx":2,"correct":true,"proposition":"Stage 3 analgesic","justification":""},{"idx":3,"correct":true,"proposition":"Protection of the limb by avoiding compression points","justification":""},{"idx":4,"correct":true,"proposition":"Intravenous arterial vasodilator therapy","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-17-qi-17","context":"A 66-year-old patient consults his general practitioner for dyspnea of effort evolving for 2 months. He is still an active chef. He is overweight with a body mass index of 28 kg\/m2, type 2 diabetic and hypertensive. He has been weaned from smoking (35 packs.years) for 1 year, date of the discovery of diabetes. He drinks 2 to 3 glasses of wine a day. He receives irbesartan, metformin and rosuvastatin.","enonce":"What risk(s) is (s) to which the patient is exposed due to the occurrence of this acute ischemia? ","item":"annales-2019-dp-17","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Hypokalemia","justification":""},{"idx":1,"correct":true,"proposition":"Metabolic acidosis","justification":""},{"idx":2,"correct":true,"proposition":"Acute renal failure","justification":""},{"idx":3,"correct":true,"proposition":"Heart rhythm disorders","justification":""},{"idx":4,"correct":false,"proposition":"Acute liver failure","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-18-qi-1","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"What are the diagnoses to evoke in front of dysphonia (one or more expected responses) in this patient? ","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Polyp of vocal folds (vocal cords)","justification":""},{"idx":1,"correct":false,"proposition":"Intracordal nodule","justification":""},{"idx":2,"correct":true,"proposition":"Cancer of the vocal folds (vocal cords)","justification":""},{"idx":3,"correct":true,"proposition":"Unilateral laryngeal immobility","justification":""},{"idx":4,"correct":false,"proposition":"Oropharyngeal cancer","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-18-qi-2","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"Which of the following risk factors promote the development of vocal fold cancer (one or more expected responses)?","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Isolated ethyl poisoning","justification":""},{"idx":1,"correct":true,"proposition":"Alcohol and tobacco poisoning","justification":""},{"idx":2,"correct":true,"proposition":"Isolated tobacco poisoning","justification":""},{"idx":3,"correct":false,"proposition":"Infection à Hu man Papilloma Virus","justification":""},{"idx":4,"correct":false,"proposition":"Infection à Epstein Barr Virus","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-18-qi-3","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"The patient is seen in consultation with 0RL. Among the following tests, which are those that make it possible to evoke the diagnosis of laryngeal cancer during a 0RL consultation (one or more expected answers):","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Acoustic voice analysis","justification":""},{"idx":1,"correct":true,"proposition":"Laryngeal fibroscopy","justification":""},{"idx":2,"correct":true,"proposition":"Indirect LaryngoscoP.ie","justification":""},{"idx":3,"correct":false,"proposition":"Laryngeal videostroboscopy","justification":""},{"idx":4,"correct":false,"proposition":"Panendoscopy of the upper aerodigestive tract","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-18-qi-4","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"You are moving towards the diagnosis of laryngeal cancer. Which of the following functional signs is related to a significant spread of cancer (one or more expected responses)?","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Otalgia right reflex","justification":""},{"idx":1,"correct":true,"proposition":"Dysphagia to solids","justification":""},{"idx":2,"correct":true,"proposition":"Laryngeal dyspnea","justification":""},{"idx":3,"correct":true,"proposition":"Bloody Spit","justification":""},{"idx":4,"correct":true,"proposition":"Swallowing disorders with false routes mainly when ingesting fluids","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-18-qi-5","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"During the clinical examination of the patient, what are the essential gestures to be performed (one or more expected answers)? ","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Dental examination","justification":""},{"idx":1,"correct":true,"proposition":"Complete inspection of the oropharynx and oral cavity","justification":""},{"idx":2,"correct":true,"proposition":"Endooral palpation","justification":""},{"idx":3,"correct":false,"proposition":"Otoscopy","justification":""},{"idx":4,"correct":true,"proposition":"Precise examination of lymph node areas","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-18-qi-6","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"You highlight cervical lymphadenopathy. What are the elements to be specified during the clinical examination (one or more expected answers)?","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Seat"},{"idx":1,"correct":true,"proposition":"Waist"},{"idx":2,"correct":true,"proposition":"Deep infiltration"},{"idx":3,"correct":true,"proposition":"Skin condition in relation to"},{"idx":4,"correct":false,"proposition":"Compression of the internal jugular vein","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-18-qi-7","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"At the end of your clinical examination, you perform a pharyngolaryngeal nasofibroscopy. You highlight a tumor of the right hemilarynx with the presence of several right cervical lymphadenopathy. What are the important elements missing from the description of your clinical examination (one or more expected answers)? ","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Tumour colour","justification":""},{"idx":1,"correct":true,"proposition":"Macroscopic appearance of the tumour","justification":""},{"idx":2,"correct":true,"proposition":"Mobility of the right arytenoid","justification":""},{"idx":3,"correct":true,"proposition":"Mobility of the right vocal fold","justification":""},{"idx":4,"correct":true,"proposition":"Tumour size","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-18-qi-8","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"For this patient, what are the examinations you request as part of the locoregional and general extension assessment (one or more expected answers)? ","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"PET scanner","justification":""},{"idx":1,"correct":false,"proposition":"Ultrasound of the vessels of the neck","justification":""},{"idx":2,"correct":false,"proposition":"Cervical MRI","justification":""},{"idx":3,"correct":true,"proposition":"Cervico-thoracic CT with injection","justification":""},{"idx":4,"correct":true,"proposition":"Panendoscopy of the upper aerodigestive tract under general anesthesia","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-18-qi-9","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"You decide to perform a panendoscopy of the upper aerodigestive tract under general anesthesia. An anesthesia consultation is mandatory. What are the characteristics of this consultation (one or more expected answers)? ","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"It is governed by a decree of the Public Health Code","justification":""},{"idx":1,"correct":false,"proposition":"It is performed by the anaesthetist who will practice anesthesia during surgery","justification":""},{"idx":2,"correct":true,"proposition":"Informing the patient about the anesthesia procedure is mandatory","justification":""},{"idx":3,"correct":false,"proposition":"It is performed by any doctor regardless of his specialty","justification":""},{"idx":4,"correct":true,"proposition":"It is performed at least 48 hours before panendoscopy","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-18-qi-10","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"Which of the following biological examinations is essential before performing panendoscopy? ","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Calcium phosphate balance","justification":""},{"idx":1,"correct":false,"proposition":"Carcinoembryonic antigen (CEA) test","justification":""},{"idx":2,"correct":false,"proposition":"Determination of transaminases","justification":""},{"idx":3,"correct":false,"proposition":"CRP testing","justification":""},{"idx":4,"correct":true,"proposition":"Haemostasis assessment including INR, TCA, p lacquettes","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-18-qi-11","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"The cervico-thoracic CT scan was performed. What are the exact proposals (one or more expected answers)? ","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"1 refers to cricoid cartilage","justification":""},{"idx":1,"correct":true,"proposition":"1 refers to thyroid cartilage","justification":""},{"idx":2,"correct":false,"proposition":"2 refers to epiglottic cartilage","justification":""},{"idx":3,"correct":true,"proposition":"2 refers to the laryngeal tumour","justification":""},{"idx":4,"correct":true,"proposition":"3 refers to the sternocleidostoid muscle","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-18-qi-12","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"At the end of all the examinations performed, the final diagnosis is a moderately differentiated squamous cell carcinoma of the right hemianx classified T3N2bM0. What are the mandatory rules to respect for the management of a patient with carcinoma (one or more expected responses)? ","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Decision on taking charge in a multidisciplinary consultation meeting (RCP)","justification":""},{"idx":1,"correct":true,"proposition":"Management defined in agreement with the patient","justification":""},{"idx":2,"correct":true,"proposition":"Care at an authorized facility","justification":""},{"idx":3,"correct":true,"proposition":"Mandatory notification consultation","justification":""},{"idx":4,"correct":true,"proposition":"Application for inclusion on the list of long-term conditions made by the attending physician","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-18-qi-13","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"During the multidisciplinary consultation meeting, it was decided to propose a laryngeal preservation strategy with two chemotherapy courses combining cisplatin, 5FU, Docetaxel. Which of the following complications could be related to cisplatin (one or more expected responses)?","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Renal failure","justification":""},{"idx":1,"correct":true,"proposition":"Hearing loss","justification":""},{"idx":2,"correct":false,"proposition":"Mucite","justification":"The college of oncology does not report it! We were as surprised as you probably are now 😖."},{"idx":3,"correct":true,"proposition":"Dysesthesia of the extremities","justification":""},{"idx":4,"correct":true,"proposition":"Nausea, vomiting","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-18-qi-14","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"Because of the 5FU treatment, what toxicity do you monitor first? (Only one answer expected)","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":false,"proposition":"Neurological toxicity","justification":""},{"idx":1,"correct":false,"proposition":"Liver toxicity","justification":""},{"idx":2,"correct":true,"proposition":"Cardiac toxicity","justification":"Beware of coronary spasms"},{"idx":3,"correct":false,"proposition":"Digestive toxicity","justification":""},{"idx":4,"correct":false,"proposition":"Renal toxicity","justification":""}],"type":"dp"}
+{"_id":"annales-2019-dp-18-qi-15","context":"A 68-year-old patient, a tobacco maker, is referred for dysphonia that has been evolving for 4 months. There is a history of atrial fibrillation treated with an anti-vitamin K. The last INR check performed 10 days ago was at 2.4. He started treatment including amoxicillin at a dose of 1g x 3\/day in self-medication which he continued for 3 days without any improvement. The clinical examination carried out reveals moderate dysphonia. The blood pressure measurement is 120\/85 mmHg, the height is 172 cm and the weight is stable at 75 Kg.","enonce":"After two courses of chemotherapy, a regression of tumor volume greater than 50% associated with remobilization of the right hemilarynx was highlighted. was decided to perform cetuximab-sensitized radiotherapy. What are the complications of radiotherapy that could be observed in the medium or long term (one or more expected responses)?","item":"annales-2019-dp-18","matiere":"annales-2019","propositions":[{"idx":0,"correct":true,"proposition":"Hyposialia","justification":""},{"idx":1,"correct":true,"proposition":"Hypothyroidism","justification":""},{"idx":2,"correct":true,"proposition":"Laryngeal edema","justification":""},{"idx":3,"correct":true,"proposition":"Laryngeal dyspnea","justification":""},{"idx":4,"correct":true,"proposition":"Cervical sclerosis","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-1-qi-1","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"What is your main diagnostic hypothesis? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Obliterating arterial disease of the lower limbs","justification":"This is the typical presentation"},{"idx":1,"correct":false,"proposition":"Narrow lumbar canal","justification":""},{"idx":2,"correct":false,"proposition":"Lombosciatica","justification":""},{"idx":3,"correct":false,"proposition":"Hypokalemia","justification":""},{"idx":4,"correct":false,"proposition":"Deep vein thrombosis","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-1-qi-2","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"You suspect arterial disease obliterating the lower limbs. Which of the following semiological elements will guide the diagnosis towards this hypothesis? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Occurrence of pain when walking","justification":""},{"idx":1,"correct":true,"proposition":"Symptomatology type of calf cramp","justification":""},{"idx":2,"correct":false,"proposition":"Reduction of pain by leaning forward","justification":"This is the description of the famous shopping cart sign, found in the narrowed lumbar canal"},{"idx":3,"correct":false,"proposition":"Disappearance of pain gradually for several hours","justification":"Decrease in pain at cessation of exertion in PAD. It is the onset of pain that is progressive."},{"idx":4,"correct":true,"proposition":"Faster onset of symptoms when the patient climbs a slope","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-1-qi-3","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"The interrogation confirms the appearance of a pain when walking with a cramp type localized in the right calf. The pain manifests itself early when the patient climbs a slope, thus supporting your diagnostic hypothesis of arterial obliterating disease of the lower limbs. On clinical examination, the patient measures 1.77 m, weighs 70 kg and the blood pressure is 134\/68 mmHg in both arms. Abdominal palpation does not perceive pulsatile or expansive mass. At the level of the lower left limb all peripheral pulses are found, the popliteal pulse seems however too well perceived. At the level of the lower right limb, only the femoral pulse is found. At auscultation you will find only a right cervical murmur and a murmur in the upper 1\/3 of the left thigh. On the data of this clinical examination, which is(are) the arterial atheromatous lesion(s) that you should suspect?","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Stenosis of the right external iliac artery","justification":""},{"idx":1,"correct":true,"proposition":"Left common femoral artery stenosis","justification":"The perception of a murmur on auscultation points to stenosis of the artery. Not to be confused with an obliteration, which corresponds to a total stenosis, that is to say that the blood does not pass at all. At the auscultation of an obliteration, we do not find a breath. On palpation of an obliteration, no pulse is found."},{"idx":2,"correct":true,"proposition":"Right common femoral artery stenosis","justification":"No pulse = total stenosis."},{"idx":3,"correct":true,"proposition":"Left popliteal artery aneurysm","justification":"Pulse too well perceived = aneurysm"},{"idx":4,"correct":false,"proposition":"Left leg artery stenosis","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-1-qi-4","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"You mention the existence of a stenosis of the left femoral artery, a left popliteal aneurysm and a right femoral obliteration-reinjection. To confirm the diagnosis of obliterating arterial disease of the lower limbs you perform a measurement of the Systolic Pressure Index (SPI) in the ankle. The SPI is 0.67 at the lower right limb and 0.85 at the left lower limb. What are the semiological value and limitations of this parameter? (one or more correct answers). ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"When the SNI is less than 0.90, it confirms the diagnosis of peripheral arterial disease","justification":"The SPI standard is between 0.9 and 1.3 (1.4 is found as the higher standard in some sources). Below 0.9, he signs an AOMI. Above 1.3 (or 1.4), it signs arterial incompressibility (found in diabetic patients and chronic renal failure dialysis) due to mediacalcosis (calcification of the media, the intermediate tunica of the vessels, between the intima and the weed). An IPS below 0.7 indicates severe PAD."},{"idx":1,"correct":true,"proposition":"When the SNI is less than 0.90, it indicates an over-risk of cardiovascular morbidity and mortality","justification":""},{"idx":2,"correct":true,"proposition":"When the SPI is greater than 1.40, it indicates arterial stiffness associated with mediacalcosis","justification":""},{"idx":3,"correct":true,"proposition":"The presence of a mediacalcosis requires the use of toe pressure and not ankle pressure for the calculation of the IPS","justification":"This is the way we have found to counter the mediacalcolsis. The arteries of the toe are less prone to medicalcolsis. However, it should not be forgotten that it is physiological that the pressure of the toe is lower than the pressure of the ankle. The standard is therefore lower. Indeed, in case of taking the voltage of the ortel, the standard of the IPS is then 0.7"},{"idx":4,"correct":false,"proposition":"ABI should be measured in patients suspected of acute sensory-motor ischemia to confirm diagnosis","justification":"Acute limb ischemia is a medical-surgical, functional and even vital emergency. No examination should slow down management."}],"type":"dp"}
+{"_id":"annales-2020-dp-1-qi-5","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"To specify the arterial lesion assessment, which is (are) the additional first-line examination(s) you are requesting? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"arteriography of the aorta and lower limbs","justification":""},{"idx":1,"correct":true,"proposition":"Doppler ultrasound of the abdominal aorta and arteries of the lower limbs","justification":"Makes it possible to precisely identify lesions, to evaluate the degree of stenosis and to objectify functional adaptation."},{"idx":2,"correct":true,"proposition":"a Doppler ultrasound of arterial axes for cervico-encephalic purposes","justification":"In the previous questions, the patient has a cervical murmur. It must therefore be explored."},{"idx":3,"correct":false,"proposition":"angio-MRI of the arterial axes for cervico-encephalic","justification":""},{"idx":4,"correct":false,"proposition":"CT angiography of the aorta and lower limbs","justification":"Is done pre-operatively of a revascularization"}],"type":"dp"}
+{"_id":"annales-2020-dp-1-qi-6","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"You asked in first intention the realization of a Doppler ultrasound of the axes for cervico-encephalic use, the aorta and the lower limbs to specify the arterial lesions. This objective examination an atheromatous overload at the level of the arterial axes of the supra-aortic trunks without significant stenosis. The abdominal aorta is regular and measures 28 mm in anteroposterior diameter. There is an obliteration of the right femoral artery with reinjection of the popliteal artery. There is also stenosis in the middle third of the left femoral artery. The left popliteal artery is regular and measures 13 mm in diameter in its widest dimension. Given the absence of a threatening lesion, you decide to treat this patient medically. What therapeutic measure(s) are you going to put in place? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Statine","justification":"Drug treatment of intermittent claudication is based on anti-platelet aggregation (by aspirin at anti-aggregating dose), an inhibitor of the converting enzyme (ACE inhibitor, the patient is already on perindopril for his hypertension, so we will keep it), and a statin (with an LDLc goal of less than 0.7 g \/ L because we are in secondary prevention,  the lesions are already there). It is associated with therapeutic education (sports activity, smoking cessation, Mediterranean diet, ...) and rehabilitation to progressive effort. Finally, we can discuss a gesture of revascularization."},{"idx":1,"correct":false,"proposition":"Beta-blocker to replace perindopril","justification":"ACE inhibitor is the treatment of choice in PAD"},{"idx":2,"correct":true,"proposition":"Antiplatelet agent","justification":"Treatment formally indicated from the stage of intermittent claudication. It is discussed in case of completely asymptomatic PAD (rare case)."},{"idx":3,"correct":false,"proposition":"Direct oral anticoagulant","justification":"We are not dealing with a coagulation problem. Neither AOD nor Heparin are therefore indicated. Indeed, in the arterial circuit, it is mainly a problem of primary hemostasis (platelet aggregation and formation of a thrombus) that may arise."},{"idx":4,"correct":false,"proposition":"Low molecular weight heparin","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-1-qi-7","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"In addition to drug treatment, what advice(s) will you give to your patient? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Smoking cessation","justification":"The patient still smokes"},{"idx":1,"correct":false,"proposition":"Low-calorie diet","justification":"He is not overweight"},{"idx":2,"correct":false,"proposition":"Strict salt-free diet","justification":"His high blood pressure seems to be under control. Even if this were not the case, we would potentially advise a low-sodium (<6g\/D) and unsodized (<4g\/D) diet. The latter, the soda diet, is reserved for cases of cirrhosis with refractory ascites for example."},{"idx":3,"correct":false,"proposition":"Hypoglycemic diet","justification":"He is not diabetic"},{"idx":4,"correct":true,"proposition":"30-minute walk a day 5 times a week","justification":"That's 150 minutes of physical activity per week"}],"type":"dp"}
+{"_id":"annales-2020-dp-1-qi-8","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"You see the patient again after 6 months of treatment and prescribe a treadmill walking test. Regarding this review, what is the exact proposal(s)? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"It makes it possible to assess the disability related to arterial disease obliterans of the lower limbs ","justification":"The shorter the patient can walk, the greater the disability."},{"idx":1,"correct":false,"proposition":"It makes it possible to measure in a standardized way the distance traveled in 6 minutes","justification":"This proposal refers to the 6-minute walking test (TM6), useful in pulmonology. It consists of measuring the distance that a patient can travel in 6 minutes. Here, the test of walking on a treadmill is something else entirely: the patient puts himself on a treadmill advancing at 3.2km\/h with a slope of 10%, and he walks as long as possible (no time limit)."},{"idx":2,"correct":true,"proposition":"It allows a reassessment of SNPs after walking","justification":"The SPI is evaluated after walking and compared to that at rest."},{"idx":3,"correct":false,"proposition":"It is only intended for patients with mediacalcosis","justification":"There is no real connection with medicalcosis 😅"},{"idx":4,"correct":true,"proposition":"It allows the evaluation of the functional value of collateral circulation","justification":"The longer the patient can walk, the more the collateral circulation ensures a satisfactory locum function."}],"type":"dp"}
+{"_id":"annales-2020-dp-1-qi-9","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"The walking test shows only moderate functional disability, compatible with continued medical treatment. The cardiologist consulted beforehand performed a stress ultrasound on dobutamine which does not show signs of myocardial ischemia. Resting echocardiography is also normal, with the exception of the presence of dilatation of the left atrium. Smoking cessation is ongoing. The patient is treated with atorvastatin, aspirin and perindopril. A year later, he consulted the cardiologist for palpitations that had been evolving episodically for several weeks. What is the possible cause(s) of palpitations in this patient? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Atrial tachycardia","justification":"Atrial tachycardia can cause palpitations (this is what you can feel after a 100m sprint at the end of D4 🤭 #vecu)."},{"idx":1,"correct":true,"proposition":"Atrial extrasystoles","justification":"If there are many and as a result, it is possible to feel palpitations. This is also the case for ventricular extrasystoles."},{"idx":2,"correct":false,"proposition":"Paroxysmal atrioventricular block","justification":"We find rather a bradycardia. It is not a cause of palpitation."},{"idx":3,"correct":true,"proposition":"Atrial fibrillation","justification":"First etiology to look for in case of palpitations."},{"idx":4,"correct":false,"proposition":"Ventricular fibrillation","justification":"Ventricular fibrillation never returns to normal on its own, and leads to cardiorespiratory arrest quickly and death if left untreated. If the patient had had VF, we would know."}],"type":"dp"}
+{"_id":"annales-2020-dp-1-qi-10","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"An electrocardiogram is performed, of which here is the trace.","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"junctional tachycardia"},{"idx":1,"correct":true,"proposition":"atrial fibrillation"},{"idx":2,"correct":false,"proposition":"Atrial Flutter"},{"idx":3,"correct":false,"proposition":"atrial extrasystoles"},{"idx":4,"correct":false,"proposition":"sinus tachycardia"}],"type":"dp"}
+{"_id":"annales-2020-dp-1-qi-11","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"Which factor(s) were considered to assess the thromboembolic risk of atrial fibrillation in this patient? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Peripheral arterial disease (PAD)","justification":""},{"idx":1,"correct":false,"proposition":"Smoking","justification":""},{"idx":2,"correct":true,"proposition":"History of high blood pressure (hypertension)","justification":""},{"idx":3,"correct":true,"proposition":"Age","justification":""},{"idx":4,"correct":false,"proposition":"The recent nature of atrial fibrillation (AF)","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-1-qi-12","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"Renal function is normal and treatment with direct oral anticoagulant with apixaban is started due to age over 65 years, high blood pressure and peripheral arterial disease. The very reliable interrogation of the patient makes it possible to specify that palpitations occur in episodes whose duration varies between 6 and 72 hours. How to qualify this atrial fibrillation according to the data collected (only one answer)?","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Persistent","justification":""},{"idx":1,"correct":false,"proposition":"Perm","justification":""},{"idx":2,"correct":false,"proposition":"Isolated","justification":""},{"idx":3,"correct":true,"proposition":"Paroxysmal","justification":"Spontaneous reduction in less than 7 days (here 'between 6 and 72 hours' according to the statement)."},{"idx":4,"correct":false,"proposition":"Resistant","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-1-qi-13","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"This is paroxysmal atrial fibrillation. You decide to prescribe a beta-blocker to slow the frequency of atrial fibrillation. After 3 days of treatment, the patient presents to the emergency room for lipothymia and exertional dyspnea. The electrocardiogram shows only sinus bradycardia at 42 beats \/ minute. Blood pressure is normal, the patient is asymptomatic to decubitus, there is no sign of low flow, diuresis is preserved, pulmonary auscultation is normal. What is your care? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Modification of treatment and return home","justification":""},{"idx":1,"correct":true,"proposition":"Suspension of beta-blocker and resumed at reduced doses","justification":"It is probably the introduction of the beta-blocker that is at the origin of bradycardia, therefore of the patient's symptomatology. We therefore stop the offending drug, with a wash-out period, then resume in small doses when the patient stabilizes, finding a dose that optimizes the benefit\/risk balance."},{"idx":2,"correct":false,"proposition":"Placement of a percutaneous electrosystolic training probe","justification":""},{"idx":3,"correct":false,"proposition":"Isoprenaline infusion","justification":""},{"idx":4,"correct":false,"proposition":"Installation of a permanent pacemaker","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-1-qi-14","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"This is an adverse reaction of the beta-blocker whose dosage was not adequate. After dose reduction, the situation stabilizes favorably. Treatment with direct oral anticoagulant is continued. A few weeks later, the patient presents again for an attack of atrial fibrillation prolonged for more than 4 days but perfectly well tolerated under beta-blocker. You offer him an electrical cardioversion scheduled for the coming weeks. What will be the condition(s) for achieving this electrical cardioversion? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Previous transesophageal echocardiography","justification":"ETO is not useful if cardioversion is covered by 3 weeks of anticoagulation before."},{"idx":1,"correct":false,"proposition":"Relay of direct oral anticoagulant by low molecular weight heparin at curative dose","justification":"We are very happy with the AOD 😊. Furthermore, LMWHs do not have MA in atrial fibrillation. So, at the ECN, you should never tick them! The HnF will then be used."},{"idx":2,"correct":false,"proposition":"Realization at low energy under light sedation by midazolam","justification":"Must be done under general anesthesia (an external electric shock, it hurts a lot!). 😰"},{"idx":3,"correct":true,"proposition":"Anesthesia consultation","justification":"The medico-legal delay of an anesthesia consultation is at least 48 hours. The pre-anesthetic visit is carried out a few hours before."},{"idx":4,"correct":false,"proposition":"Weekly INR check for a target between 2 and 3","justification":"DOACs do not have biological monitoring parameters, which is sometimes problematic (when one needs to measure its effect exactly, for example when introducing a drug known for its enzymatic inducing effect)."}],"type":"dp"}
+{"_id":"annales-2020-dp-1-qi-15","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"Electrical cardioversion is successfully performed two weeks later. Antiarrhythmic treatment is undertaken by flecainide which makes the symptoms disappear. The patient asks you about stopping direct oral anticoagulant therapy now that the atrial fibrillation has disappeared. What do you say to him (one correct answer)? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Discontinuation of direct oral anticoagulant therapy 4 weeks after cardioversion","justification":"This proposition would have been true if he had a CHADS-VASc at 0, or if he was under 65 and a purely isolated AF."},{"idx":1,"correct":false,"proposition":"Discontinuation of direct oral anticoagulant therapy if long-term Holter recording is normal","justification":""},{"idx":2,"correct":true,"proposition":"Indefinite maintenance of direct oral anticoagulant therapy","justification":"Its CHADS-VASc at 3 requires long-term anticoagulation."},{"idx":3,"correct":false,"proposition":"Discontinuation of direct oral anticoagulant therapy after 12 months without documented relapse of atrial fibrillation","justification":""},{"idx":4,"correct":false,"proposition":"Discontinuation of direct oral anticoagulant therapy if echocardiography shows haemodynamic efficacy of atrial systole","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-1-qi-16","context":"A 67-year-old man consults for right calf pain occurring after a walk that the patient estimates to be 350 meters away. He is a retired and sedentary taxi driver. This patient has been smoking a pack of cigarettes a day since the age of 30. You follow it for high blood pressure discovered by a systematic and balanced examination by perindopril. Blood sugar is normal as well as lipid balance. ","enonce":"You continued the anticoagulant treatment. The patient asks you about the reasons for the occurrence of atrial fibrillation in his case. What do you say (one or more exact answers)? ","item":"annales-2020-dp-1","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"It is an arrhythmia frequently associated with arterial disease obliterans of the lower limbs","justification":"No report 😅🤭"},{"idx":1,"correct":false,"proposition":"It is a consequence of his smoking","justification":"Questionable proposal. Smoking is indeed a predisposing factor to heart disease, but establishing a direct link between FA tobacco 👉 seems too bold."},{"idx":2,"correct":true,"proposition":"It is a common arrhythmia in case of high blood pressure","justification":"High blood pressure is the leading cause of atrial fibrillation."},{"idx":3,"correct":false,"proposition":"It is an arrhythmia favored by its sedentary lifestyle","justification":"No report, especially in this patient who is neither diabetic nor overweight."},{"idx":4,"correct":true,"proposition":"It is an arrhythmia frequently associated with sleep apnea syndrome.","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-2-qi-1","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"What pathology(s) does the gynecological clinical examination (inspection, speculum examination and vaginal examination) allow you to eliminate with certainty? ","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"An endometrial polyp","justification":""},{"idx":1,"correct":false,"proposition":"A uterine fibroid","justification":""},{"idx":2,"correct":true,"proposition":"Vaginal cancer","justification":""},{"idx":3,"correct":false,"proposition":"Cervical dysplasia","justification":"The diagnosis of cervical dyaplsia is pathological pathology."},{"idx":4,"correct":false,"proposition":"Malignant tumor of the ovary","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-2-qi-2","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"On examination, the vaginal wall is unremarkable and the cervix is normal. Which additional exam(s) do you prescribe as a first-line treatment?","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"An x-ray of the abdomen without preparation","justification":"Hardly ticks anymore..."},{"idx":1,"correct":true,"proposition":"An abdominopelvic ultrasound","justification":"The king first-line examination in gynecology 👑"},{"idx":2,"correct":false,"proposition":"An abdomino-pelvic CT scan","justification":""},{"idx":3,"correct":false,"proposition":"Abdominopelvic magnetic resonance imaging","justification":""},{"idx":4,"correct":false,"proposition":"Hysterosalpingography","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-2-qi-3","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"A pelvic ultrasound is performed. It reveals a cystic right ovarian mass of about 6 cm with vascularized vegetation, a left hydrosalpinx and a left ovary carrying cystic formation with pure fluid content. The endometrial thickness is 18 mm with hypervascularization. There is also minimal peritoneal fluid effusion. What argument(s) is (or are) in favor of a malignant pathology? ","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Peritoneal effusion","justification":"It is minimal 👉 osef"},{"idx":1,"correct":false,"proposition":"The size of the right adnexal lesion","justification":"The size less than 7cm is a reassuring element."},{"idx":2,"correct":false,"proposition":"Left tubal lesion","justification":""},{"idx":3,"correct":false,"proposition":"Left ovarian lesion","justification":"Cystic nature is reassuring"},{"idx":4,"correct":true,"proposition":"The existence of vascularized vegetation on the right annex","justification":"The intense vascularization of a lesion is often in favor of malignancy (by secretion of VEGF from tumor cells)."}],"type":"dp"}
+{"_id":"annales-2020-dp-2-qi-4","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"In this context, the right ovarian lesion as well as the endometrial thickness worry you. What other imaging exam(s) will you perform? ","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Abdominopelvic magnetic resonance imaging with Gadolinium injection","justification":""},{"idx":1,"correct":false,"proposition":"A brain scan","justification":""},{"idx":2,"correct":false,"proposition":"Fluoro-Deoxy-Glucose positron emission tomography","justification":""},{"idx":3,"correct":false,"proposition":"A bone scan","justification":""},{"idx":4,"correct":false,"proposition":"A liver ultrasound","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-2-qi-5","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"Along with the MRI you request. What biological marker(s) will you dose for this patient? ","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Ca 125","justification":"Ovarian cancer marker"},{"idx":1,"correct":false,"proposition":"Alfa-fetoprotein","justification":""},{"idx":2,"correct":false,"proposition":"Beta-HCG","justification":"Look at the patient's 😉 age (and don't blame yourself for checking it, but make sure you NEVER get caught up in this trap 🤗)"},{"idx":3,"correct":false,"proposition":"Ca 19.9","justification":"Marker of ovarian cancer. ACE and HE4 would be added. Note that the use of these markers is discussed."},{"idx":4,"correct":false,"proposition":"SCC","justification":"Marker of squamous cell cancers"}],"type":"dp"}
+{"_id":"annales-2020-dp-2-qi-6","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"The results of the markers: \n\nCA 15.3: 25U\/mL \n\nCA 125: 40 Ul\/ml. \n\nA pelvic MRI is performed. The radiologist confirms the strong suspicion of malignant lesion of the right ovary and endometrium, as well as the a priori benign nature of the lesions of the left appendix. What do you do to support the diagnosis? (one or more possible answer(s)) ","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Puncture of the peritoneal effusion vaginally","justification":""},{"idx":1,"correct":false,"proposition":"Right ultrasound-guided ovarian biopsy vaginally","justification":""},{"idx":2,"correct":true,"proposition":"Diagnostic hysteroscopy","justification":"For the endometrium"},{"idx":3,"correct":true,"proposition":"Laparoscopy explorer","justification":"For the ovary"},{"idx":4,"correct":false,"proposition":"Right ovarian biopsy under CT scan","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-2-qi-7","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"Laparoscopy is performed. What do you expect? (one or more possible answer(s)) ","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Surgical removal of the right ovary","justification":""},{"idx":1,"correct":false,"proposition":"Staging swab","justification":""},{"idx":2,"correct":false,"proposition":"Surgical endometrial sampling","justification":"The endometrium is not removed directly."},{"idx":3,"correct":true,"proposition":"Assessment of the resectability of lesions","justification":""},{"idx":4,"correct":true,"proposition":"Assessment of peritoneal extension of the disease","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-2-qi-8","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"Laparoscopy did not show peritoneal extension. The histological results of the endometrial sample are: grade II invasive endometrioid adenocarcinoma. The histological results of the right adnexal swab: an intraovarian endometrioid adenocarcinoma lesion without extension to the surface or tubal wall. What treatment should be performed? ","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"A total hysterectomy with bilateral appendectomy","justification":""},{"idx":1,"correct":false,"proposition":"Expanded colpohysterectomy with bilateral appendectomy","justification":"The cervix is healthy. There is no indication to remove it."},{"idx":2,"correct":false,"proposition":"Abdominopelvic external beam radiation therapy combined with concomitant chemotherapy","justification":""},{"idx":3,"correct":false,"proposition":"Neoadjuvant chemotherapy","justification":""},{"idx":4,"correct":false,"proposition":"Tamoxifen-based hormone therapy","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-2-qi-9","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"Regarding the epidemiological data of the type of endometrial cancer (endometrioid) of this patient, what is(are) the exact statement(s)?","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"It is the most common gynecological (pelvic) cancer","justification":""},{"idx":1,"correct":true,"proposition":"It is a cancer of epithelial origin","justification":""},{"idx":2,"correct":true,"proposition":"It is a hormone-dependent cancer","justification":""},{"idx":3,"correct":false,"proposition":"It is a cancer of poor prognosis","justification":""},{"idx":4,"correct":true,"proposition":"Tamoxifen is a risk factor","justification":"Because hormone-dependent cancer"}],"type":"dp"}
+{"_id":"annales-2020-dp-2-qi-10","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"The patient's file is presented at a multidisciplinary consultation meeting (RCP). Regarding CPR, what is(es) the correct answer(s)? ","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"It is not mandatory pre-operative","justification":"Except in very special cases (emergency for example), CPR is mandatory"},{"idx":1,"correct":false,"proposition":"It is the referring surgeon who proposes a therapeutic strategy","justification":""},{"idx":2,"correct":true,"proposition":"Doctors from three different specialties must be present","justification":""},{"idx":3,"correct":false,"proposition":"The support person can attend CPR","justification":"It's a meeting between doctors"},{"idx":4,"correct":true,"proposition":"Decisions must be based on a repository","justification":"The decision is based on the objective data of science"}],"type":"dp"}
+{"_id":"annales-2020-dp-2-qi-11","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"The patient's attending physician applies for admission to a long-term condition (ALDI. Which of the following is correct? ","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The care protocol must be drawn up by the attending physician, in consultation with the patient and the other corresponding physician(s) involved in the follow-up.","justification":""},{"idx":1,"correct":false,"proposition":"ALD recognition allows 100% coverage of all health costs","justification":""},{"idx":2,"correct":false,"proposition":"The patient will be able to enjoy the benefits of her ALD for life","justification":""},{"idx":3,"correct":true,"proposition":"ALD recognition commits the patient to respond to the controls carried out by her health insurance organization","justification":""},{"idx":4,"correct":false,"proposition":"Part of the fee overruns billed by health professionals may be covered by the ALD.","justification":"Fee overruns are not covered by ALD."}],"type":"dp"}
+{"_id":"annales-2020-dp-2-qi-12","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"Given the carcinological history of the patient and her family, what is (or are) the exact proposal(s)?","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"A family predisposition is strongly suspected","justification":""},{"idx":1,"correct":false,"proposition":"A pelvic ultrasound is indicated in her daughter","justification":""},{"idx":2,"correct":false,"proposition":"A CA15.3 assay is indicated in his daughter","justification":""},{"idx":3,"correct":true,"proposition":"An onco-genetic consultation should be recommended","justification":""},{"idx":4,"correct":true,"proposition":"A search for microsatellite instability is done on operating room","justification":"Lynch syndrome is suspected. We therefore look for the corresponding mutations on the operating room."}],"type":"dp"}
+{"_id":"annales-2020-dp-2-qi-13","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"Which familial form do you suspect first?","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Un syndrome de Lynch"},{"idx":1,"correct":false,"proposition":"A BRCA1 mutation"},{"idx":2,"correct":false,"proposition":"A BRCA2 mutation"},{"idx":3,"correct":false,"proposition":"A mutation in the PTEN gene"},{"idx":4,"correct":false,"proposition":"Un syndrome de Li-Fraumeni"}],"type":"dp"}
+{"_id":"annales-2020-dp-2-qi-14","context":"A 62-year-old patient consults for pelvic pain of progressive onset evolving for several weeks with recent occurrence of minimal vaginal bleeding. She had a normal pregnancy at the age of 42. She went through menopause at the age of 50 without hormone replacement therapy. She does not smoke, and has a body mass index of 36 kg\/m 2. Her main history is right breast cancer at the age of 45, the management of which consisted of a lumpectomy with sentinel lymph node testing followed by chemotherapy, radiotherapy and hormone therapy for 5 years. Her family history includes breast cancer in her mother at age 75, ovarian cancer in a maternal aunt at age 63 and colon cancer in her maternal uncle at age 49.","enonce":"At the end of her treatment, the patient is considered in complete remission. What monitoring do you put in place for the first two years? (one or more possible answers) ","item":"annales-2020-dp-2","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"A biannual clinical examination","justification":""},{"idx":1,"correct":false,"proposition":"A semi-annual assay of the serum marker CA 15.3","justification":"This is the CA 125 test for ovarian 🤭 cancer"},{"idx":2,"correct":false,"proposition":"An annual pelvic thoracoabdomino CT scan","justification":"No indication for systematic imaging"},{"idx":3,"correct":false,"proposition":"A biannual abdominal-pelvic ultrasound","justification":"No indication for systematic imaging"},{"idx":4,"correct":false,"proposition":"An annual mammogram","justification":"She had breast cancer 👉 Annual mammogram for life."}],"type":"dp"}
+{"_id":"annales-2020-dp-3-qi-1","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"In front of this sleep disorder, you must look for Theo:","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"An adjustment disorder","justification":"It cannot be eliminated in the face of compatible symptoms and lack of information on the duration of the disorders. There are many possible triggering factors (domestic violence, moving, entry into a small section)."},{"idx":1,"correct":false,"proposition":"Early schizophrenia","justification":""},{"idx":2,"correct":true,"proposition":"Obstructive sleep apnea syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Oppositional disorder with provocation","justification":"Sleep disorders are against this diagnosis. Irritability and anger do not seem to be taken to extremes and can be explained by lack of sleep."},{"idx":4,"correct":true,"proposition":"Reactive attachment disorder","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-3-qi-2","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"Among the symptoms presented by Theo, which is an obstructive sleep apnea syndrome? ","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Irritability","justification":""},{"idx":1,"correct":true,"proposition":"Snoring","justification":""},{"idx":2,"correct":true,"proposition":"Daytime sleepiness","justification":""},{"idx":3,"correct":false,"proposition":"Difficulty falling asleep","justification":""},{"idx":4,"correct":false,"proposition":"Refusal to sleep alone","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-3-qi-3","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"In the context of this sleep disorder, what do you recommend at first?","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Sleep hygiene tips","justification":""},{"idx":1,"correct":true,"proposition":"Behavioural measures","justification":""},{"idx":2,"correct":false,"proposition":"A prescription for melatonin","justification":""},{"idx":3,"correct":false,"proposition":"A prescription of anti-histamine for hypnotic purposes","justification":""},{"idx":4,"correct":false,"proposition":"A sleep cure","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-3-qi-4","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"You gave Theo's mother advice about sleep hygiene and how to behave with him. Six months later, you see the child again in consultation because the drowsiness is more and more marked. His school entry went well but, at times, he falls asleep in class. These phases are interspersed with phases of significant irritability associated with relational difficulties with other students. This boy is now 3 years and 6 months old, 1 meter tall and weighs 22 kilograms. The rest of the somatic clinical examination is normal. Faced with this drowsiness, among the following proposals, which is the most relevant in the first line? ","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A psychological assessment","justification":""},{"idx":1,"correct":false,"proposition":"Ventilatory polygraphy","justification":""},{"idx":2,"correct":false,"proposition":"A brain MRI","justification":""},{"idx":3,"correct":true,"proposition":"An ENT consultation","justification":""},{"idx":4,"correct":false,"proposition":"An electrocardiogram","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-3-qi-5","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"The ENT consultation diagnoses obstructive sleep apnea syndrome and finds tonsillar hypertrophy and vegetations. Theo is operated on and the drowsiness disappears. Two years later, you see Theo again in consultation at the request of the teacher who describes a very difficult behavior: he never sits, does not wait his turn in class activities, does not respect the instructions and is very slow in his school work. The mother reports that he very often loses his belongings. Theo now sleeps in his own bed but demands a night light. Besides, he wets the bed. During your consultation, he does not hold in place and cuts you off. You suspect attention deficit hyperactivity disorder (ADHD). Your diagnostic hypothesis for ADHD is based on:","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Impulsivity"},{"idx":1,"correct":true,"proposition":"Motor instability"},{"idx":2,"correct":true,"proposition":"Nocturnal enuresis","justification":"About 10% of children with isolated primary nocturnal enuresis have attention deficit hyperactivity disorder (ADHD)."},{"idx":3,"correct":true,"proposition":"Slow execution","justification":"Inattention syndrome"},{"idx":4,"correct":false,"proposition":"Fear of the dark"}],"type":"dp"}
+{"_id":"annales-2020-dp-3-qi-6","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"Apart from being overweight, the rest of your physical exam is normal. To support your diagnosis of ADHD, you propose: ","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"An ophthalmological consultation","justification":""},{"idx":1,"correct":true,"proposition":"A questionnaire to be completed by the mother","justification":""},{"idx":2,"correct":true,"proposition":"A questionnaire to be completed by the teacher","justification":""},{"idx":3,"correct":false,"proposition":"A genetic assessment","justification":""},{"idx":4,"correct":false,"proposition":"A brain MRI","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-3-qi-7","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"The diagnosis of ADHD is confirmed. There is no associated learning disability. At this stage, you recommend: ","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":" Psychotherapy","justification":""},{"idx":1,"correct":false,"proposition":"Treatment with methylphenidate","justification":"This treatment is only possible from the age of 6. Theo is only 5 years old at this question. In addition, it is proposed as a second intention."},{"idx":2,"correct":true,"proposition":"Cognitive remediation","justification":""},{"idx":3,"correct":false,"proposition":"Speech therapy","justification":""},{"idx":4,"correct":false,"proposition":"Open educational assistance (AEMO)","justification":"AEMO is decided by a juvenile judge in special cases such as abuse."}],"type":"dp"}
+{"_id":"annales-2020-dp-3-qi-8","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"Six months later, Theo is 6 years old and faced with the little evolution of his disorders, you decide to prescribe methylphenidate. This molecule: ","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Is a derivative of amphetamines","justification":""},{"idx":1,"correct":true,"proposition":"Is contraindicated before 6 years","justification":""},{"idx":2,"correct":false,"proposition":"Can be prescribed for up to 3 months","justification":"28 days, no limit on the total duration of treatment."},{"idx":3,"correct":true,"proposition":"Can be renewed by the general practitioner","justification":"Today, this proposition is true. Since 2021, the prescription and renewal of methylphenidate can be initiated by any neurologist, psychiatry or pediatrician and renewed by any doctor."},{"idx":4,"correct":false,"proposition":"Is prescribed without taking into account school holidays","justification":"We reduce during school holidays"}],"type":"dp"}
+{"_id":"annales-2020-dp-3-qi-9","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"A few weeks after the introduction of the treatment, you see Theo and his mother again in consultation. Which of the following symptoms reported by his mother can methylphenidate be attributed to? ","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Increased appetite","justification":"Rather anorexia at lunch"},{"idx":1,"correct":true,"proposition":"Abdominal pain","justification":""},{"idx":2,"correct":true,"proposition":"Headaches","justification":""},{"idx":3,"correct":false,"proposition":"A sad mood","justification":""},{"idx":4,"correct":true,"proposition":"Difficulty falling asleep","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-3-qi-10","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"Three years later, Theo is admitted to the pediatric emergency room for a major attack of agitation at home. In a fit of anger, he broke his tablet and threatened to jump out of the window. He has just learned from his mother that his father, whom he did not know, committed suicide. You learn on this occasion that his mother lives with a new spouse and that intra-family relations are very tense, especially between Theo and his stepfather. Theo is now 9 years old and is enrolled in CE2. When you meet him, alone, he is calm and tells you about his discomfort. Overweight is manifest and badly experienced. Between sobs, he says: <<I'm tired of it, it's been going on too long. I can't take it anymore. >> In pediatric emergencies, management includes: ","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A prescription of an anti-histamine for anxiolytic purposes","justification":"It is described as calm at present."},{"idx":1,"correct":false,"proposition":"A prescription of a benzodiazepine for anxiolytic purposes","justification":""},{"idx":2,"correct":true,"proposition":"A referral to hospitalization","justification":""},{"idx":3,"correct":false,"proposition":"A report","justification":""},{"idx":4,"correct":false,"proposition":"A summons from the father-in-law","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-3-qi-11","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"Which of the following proposals is one or more of Theo's emergency hospitalization objectives? ","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Prevention of suicidal risk","justification":""},{"idx":1,"correct":true,"proposition":"Prolonged clinical observation","justification":""},{"idx":2,"correct":false,"proposition":"Reassessment of ADHD treatment","justification":"This is not an indication for emergency hospitalization"},{"idx":3,"correct":true,"proposition":"Distancing intra-family tensions","justification":""},{"idx":4,"correct":false,"proposition":"Multidisciplinary assessment","justification":"This is not an indication for emergency hospitalization"}],"type":"dp"}
+{"_id":"annales-2020-dp-3-qi-12","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"Theo is hospitalized in pediatrics. During an interview, he described sexual touching by his stepfather but refused to be told about it to his mother. Faced with this situation ","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"You avoid informing the mother","justification":""},{"idx":1,"correct":true,"proposition":"You make a report even if the mother objects","justification":""},{"idx":2,"correct":true,"proposition":"You make a report even without Theo's agreement","justification":""},{"idx":3,"correct":false,"proposition":"You identify the father-in-law on your certificate as responsible for the facts","justification":""},{"idx":4,"correct":false,"proposition":"You avoid transcribing Theo's words word for word","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-3-qi-13","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"To whom do you address your report?","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"To the Child Social Assistance (ASE)","justification":""},{"idx":1,"correct":false,"proposition":"To the social worker of the paediatric department","justification":""},{"idx":2,"correct":false,"proposition":"To the regional health agency (ARS)","justification":""},{"idx":3,"correct":true,"proposition":"To the public prosecutor","justification":""},{"idx":4,"correct":false,"proposition":"Maternal and Child Protection (PMI)","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-3-qi-14","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"The mother's spouse admits the facts and is incarcerated. A few weeks after his release from the hospital, Theo says he is reassured but remains sad and worried about his future. He is still treated with methylphenidate, which allows him to be calmer, but still has great academic difficulties. He has few classmates and often misses school due to somatic complaints. In view of this clinical picture, which diagnosis(s) should be mentioned?","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Depression","justification":""},{"idx":1,"correct":true,"proposition":"School phobia","justification":""},{"idx":2,"correct":false,"proposition":"Schizotypal personality disorder","justification":"A minor patient is not diagnosed with a personality disorder."},{"idx":3,"correct":false,"proposition":"Autism spectrum disorder","justification":""},{"idx":4,"correct":false,"proposition":"Conduct disorder","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-3-qi-15","context":"You receive in consultation of general medicine the young Theo, aged 3 years, in the company of his mother, for sleep disorders. Theo is the only child of this single mother, her spouse having left him at the birth of the child. Theo does not know his father. The mother has no job, and has had to move twice since Theo was born, especially after a recent affair with an abusive man. Theo refuses to go to bed and every night he cries. He only manages to fall asleep late, in the bed of his mother who tells you she is exhausted. In addition, he snores and wakes up several times a night, restless. During the day, between phases of drowsiness, he is irritable and angry. The start of the school year in kindergarten is imminent and Theo's mother is worried about her son's troubles.","enonce":"Which of the following measures, due to his situation and his difficulties at school, which can be put in place for Theo? ","item":"annales-2020-dp-3","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"An individualized reception project (PAI)","justification":"The PAI makes it possible to arrange Theo's reception by informing his pedagogical managers of his pathology."},{"idx":1,"correct":true,"proposition":"Open educational assistance (AEMO)","justification":"Theo has been put in danger and his current social context is difficult. Mentioning an AEMO will allow the juvenile judge to assess the need for support for Theo."},{"idx":2,"correct":true,"proposition":"An allowance for the education of disabled children (AEEH)","justification":"The request is made to the MDPH."},{"idx":3,"correct":true,"proposition":"A personalized support project (PAP)","justification":"The PAP concerns learning disabilities, from which Theo seems to suffer."},{"idx":4,"correct":true,"proposition":"A school life assistant (AVS)","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-4-qi-1","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"What is the BMI (body mass index) in rounded value of this patient? ","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"25","justification":""},{"idx":1,"correct":true,"proposition":"30","justification":""},{"idx":2,"correct":false,"proposition":"35","justification":""},{"idx":3,"correct":false,"proposition":"40","justification":""},{"idx":4,"correct":false,"proposition":"45","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-4-qi-2","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"Which is (are) the most likely diagnostic hypothesis(s) in front of this clinical picture?","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Stasis dermohypodermatitis","justification":""},{"idx":1,"correct":true,"proposition":"Bacterial dermohypodermatitis","justification":""},{"idx":2,"correct":false,"proposition":"Necrotizing fasciitis","justification":""},{"idx":3,"correct":false,"proposition":"Lymphangitis","justification":""},{"idx":4,"correct":false,"proposition":"Erythema nodosum","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-4-qi-3","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"What clinical characteristic(s) is (are) in favor of non-necrotizing bacterial dermohypodermatitis? ","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Brutal start","justification":""},{"idx":1,"correct":false,"proposition":"Slow expansion","justification":"Expansion is fast"},{"idx":2,"correct":false,"proposition":"Centripetal evolution of skin lesions","justification":"Centrifugal evolution"},{"idx":3,"correct":false,"proposition":"Severe spontaneous pain","justification":"Palpation pain"},{"idx":4,"correct":true,"proposition":"Demonstration of intertoe intertrigo","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-4-qi-4","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"What comorbidity(ies) present in this patient is(are) a risk factor(s) for the occurrence of bacterial dermohypoderma? ","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Obesity","justification":""},{"idx":1,"correct":false,"proposition":"Diabetes","justification":"Risk factor for necrotizing dermohypodermitis."},{"idx":2,"correct":true,"proposition":"Venous insufficiency","justification":""},{"idx":3,"correct":false,"proposition":"History of phlebitis","justification":""},{"idx":4,"correct":false,"proposition":"High blood pressure","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-4-qi-5","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"You have several elements to orient you towards bacterial dermohypodermatitis especially as you find an intertrigo of the 2 feet. What gesture(s) do you perform in front of this lesion?","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Search for an increase in local skin temperature","justification":""},{"idx":1,"correct":true,"proposition":"Stripping of a small bullous detachment within the erythematous zone","justification":""},{"idx":2,"correct":false,"proposition":"Bacteriological swab of the most inflammatory area of erythema","justification":""},{"idx":3,"correct":true,"proposition":"Marking erythema contours with felt","justification":""},{"idx":4,"correct":true,"proposition":"Investigation of lymphadenopathy","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-4-qi-6","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"Palpation of the inguinal folds objective left inguinal lymphadenopathy. What is (are) the most likely cause(s) of this left inguinal lymphadenopathy?","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Concomitant inflammatory pathology of the small pelvis","justification":""},{"idx":1,"correct":false,"proposition":"Concomitant inflammatory pathology of the perineal region","justification":""},{"idx":2,"correct":false,"proposition":"Concomitant or perianal lesion","justification":""},{"idx":3,"correct":true,"proposition":"Satellite lymphadenopathy of dermohypodermatitis","justification":""},{"idx":4,"correct":false,"proposition":"Sentinel lymphadenopathy of lymphoma","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-4-qi-7","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"What is essential to achieve before starting the therapeutic management of this dermohypodermitis? (only one answer expected)","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Blood","justification":"Namely: blood cultures are positive in less than 5% of cases and are only to be performed in a particular context (bite, travel, occurring in an aquatic environment, post-traumatic, immunosuppression, nosocomial context, signs of clinical or biological seriousness)."},{"idx":1,"correct":false,"proposition":"Skin biopsy with culture","justification":""},{"idx":2,"correct":false,"proposition":"Doppler ultrasound of the leg","justification":""},{"idx":3,"correct":false,"proposition":"Left leg scanner"},{"idx":4,"correct":true,"proposition":"No additional assessment is essential","justification":"The form is typical and uncomplicated 👉 no additional examination. The diagnosis is clinical."}],"type":"dp"}
+{"_id":"annales-2020-dp-4-qi-8","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"Which infectious agent(s) is (are) most likely to be involved? ","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Streptococcus pyogenes","justification":""},{"idx":0,"correct":false,"proposition":"coagulase-negative staphylococcus","justification":"These are low-virulent staphylococci that are present on the skin commensally. These are often contaminants (S. Epidermidis ++)."},{"idx":0,"correct":false,"proposition":"Candida albicans","justification":""},{"idx":0,"correct":false,"proposition":"Pseudomonas ","justification":""},{"idx":0,"correct":false,"proposition":"Escherichia coli","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-4-qi-9","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"What is your first-line anti-infectious therapeutic option(s) (knowing that you decide to treat her at home because of the lack of signs of severity and that she has no known allergy)?","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Oral amoxicillin","justification":""},{"idx":0,"correct":false,"proposition":"Amoxicillin - Clavulanic Acid Orally"},{"idx":0,"correct":false,"proposition":"Pristinamycin orally (PO)","justification":"It is a treatment to be used in case of allergy to amoxicillin."},{"idx":0,"correct":false,"proposition":"Oral clindamycin","justification":"It is a treatment to be used in case of allergy to amoxicillin."},{"idx":0,"correct":false,"proposition":"3rd generation cephalosporin as intramuscular injection","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-4-qi-10","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"What associated treatment do you prescribe?","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Paracetamol","justification":""},{"idx":1,"correct":false,"proposition":"Nonsteroidal anti-inflammatory drugs","justification":""},{"idx":2,"correct":false,"proposition":"Calciparin curative dose","justification":""},{"idx":3,"correct":true,"proposition":"Rest with elevation of the left leg","justification":"This helps to evacuate the edema that accompanies the inflammatory phenomenon."},{"idx":4,"correct":true,"proposition":"Treatment of intertrigo","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-4-qi-11","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"You treat it with amoxicillin and paracetamol and plan to see it again 2 days later. Indeed, this patient is exposed to the risk of evolution to a necrotizing form. What is (are) the risk factor(s) of such a development? ","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Obesity","justification":"According to HAS, the risk factors for progression to a necrotizing form are: diabetes, nonsteroidal anti-inflammatory drugs, immunosuppression (corticosteroids, chemotherapy, immunosuppressants, chronic renal failure, cirrhosis), malnutrition, age over 60 years, intravenous drug addiction, venous insufficiency, peripheral arterial disease (PAD) and obesity. In children, chickenpox is the main risk factor for DHBN. The recommendation is here: https:\/\/www.has-sante.fr\/upload\/docs\/application\/pdf\/2019-04\/prise_en_charge_des_infections_cutanees_bacteriennes_courantes_recommandations.pdf"},{"idx":1,"correct":true,"proposition":"Diabetes","justification":""},{"idx":2,"correct":false,"proposition":"Smoking","justification":""},{"idx":3,"correct":true,"proposition":"Arterial disease of the lower limbs","justification":""},{"idx":4,"correct":true,"proposition":"Taking nonsteroidal anti-inflammatory drugs","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-4-qi-12","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"Under treatment, dermohypodermatitis disappears. You see the patient again 3 months later because her company sends her to do an accounting in Abidjan in Côte d'Ivoire for 3 weeks. She has never traveled to Africa. What vaccination(s) do you offer? ","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Update of its diphtheria-tetanus-polio vaccines","justification":""},{"idx":1,"correct":true,"proposition":"Hepatitis A vaccine","justification":""},{"idx":2,"correct":true,"proposition":"Meningitis vaccine ACYW135","justification":"This proposal is contentious. This vaccine is indicated in case of close and prolonged contact with the local population in an epidemic\/endemic area. Is this the case in the case of public accounting? It's hard to know 🤷 ♂️."},{"idx":3,"correct":true,"proposition":"Yellow fever vaccine","justification":""},{"idx":4,"correct":false,"proposition":"Cholera vaccine","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-4-qi-13","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"You decide to prescribe atovaquone-proguanil for malaria chemoprophylaxis for this 3-week trip. How long do you write on the prescription? (only one answer expected) ","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"3 weeks","justification":""},{"idx":1,"correct":true,"proposition":"4 weeks","justification":"Atovaquone-Proguanil: Length of stay + 1 week (daily dose)"},{"idx":2,"correct":false,"proposition":"5 weeks","justification":""},{"idx":3,"correct":false,"proposition":"6 weeks","justification":""},{"idx":4,"correct":false,"proposition":"7 weeks","justification":"Mefloquine: 1 week before + Length of stay + 3 weeks (weekly intake). \n\nDoxycycline: Length of stay + 4 weeks\/1 month (daily intake)"}],"type":"dp"}
+{"_id":"annales-2020-dp-4-qi-14","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"Upon her return from Côte d'Ivoire, the patient consults you again. She is doing well and the stay went well. She was even able to spend the last weekend in a bush camp. She describes rudimentary facilities with poor hygiene conditions, especially on bedding. Since her return, she has slept poorly due to pruritus of her forearms, wrists and fingers. One of her colleagues with whom she shared the same room has the same symptoms. On examination you see especially scratching lesions especially in interdigital spaces. She did not change personal care products. Which pathology do you think is most likely in this context? (only one answer expected)","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Atopic dermatitis","justification":""},{"idx":1,"correct":false,"proposition":"Pediculosis","justification":""},{"idx":2,"correct":true,"proposition":"Scabies","justification":""},{"idx":3,"correct":false,"proposition":"Larva Migrans","justification":""},{"idx":4,"correct":false,"proposition":"Contact dermatitis","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-4-qi-15","context":"A 53-year-old woman, a chartered accountant in an international company, consults your office in September for the appearance for 5 days of a lesion on her left leg (photo). She has a history of active smoking, non-insulin-dependent diabetes, high blood pressure, right sural phlebitis on an old venous insufficiency 7 years ago and arterial disease of the lower limbs known for 3 years. His current treatment includes anti-hypertensive therapy and oral antidiabetics. His diabetes has been less well balanced for several weeks. She also says she regularly takes nonsteroidal anti-inflammatory drugs due to chronic low back pain. The clinical examination found a fever at 38 ° 2 C, a pulse at 100 \/ min, a blood pressure at 15\/9, a weight at 83 kg for a height of 1m65. There is no pain when palpating the left calf. ","enonce":"You mention a scabies that is confirmed by the visualization of parasites with a dermoscope. What do you recommend? (one or more correct answers) ","item":"annales-2020-dp-4","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Treatment with ivermectin","justification":""},{"idx":1,"correct":true,"proposition":"Treatment to be renewed at 7 days","justification":""},{"idx":2,"correct":true,"proposition":"Washing clothes at least 60 °C in a long cycle","justification":""},{"idx":3,"correct":true,"proposition":"Treatment at the same time of his colleague","justification":""},{"idx":4,"correct":false,"proposition":"2-week absence from work","justification":"Eviction from the community is up to 3 days after the start of treatment if common scabies (which seems to be the case here)."}],"type":"dp"}
+{"_id":"annales-2020-dp-5-qi-1","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"You notice the lesion opposite. You mention (one or more possible answers) ","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Squamous cell carcinoma","justification":"The lesion is regular. The patient is young. The area of attack is not classic."},{"idx":1,"correct":false,"proposition":"A canker sore","justification":""},{"idx":2,"correct":true,"proposition":"A hemorrhagic bubble","justification":""},{"idx":3,"correct":false,"proposition":"A bite","justification":""},{"idx":4,"correct":false,"proposition":"An angioma","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-5-qi-2","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"This is an oral hemorrhagic bubble. Given this lesion, which etiology is most likely? ","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Severe thrombocytopenia","justification":""},{"idx":1,"correct":false,"proposition":"Willebrand disease","justification":"Willebrand disease is a pathology of primary hemostasis that is accompanied by a normal platelet count. This is a possible etiology but unlikely given the age of the patient."},{"idx":2,"correct":false,"proposition":"Hemophilia","justification":""},{"idx":3,"correct":false,"proposition":"Vitamin K deficiency","justification":""},{"idx":4,"correct":false,"proposition":"Protein C deficiency","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-5-qi-3","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"You mention severe thrombocytopenia. What other bleeding signs are you looking for? (one or more possible answers)","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"A purpura","justification":"Purpura will then be thrombocytopenic: petechial, mucocutaneous, non-infiltrated, on the trunk and upper limbs as well as on the lower limbs."},{"idx":1,"correct":true,"proposition":"Gingivorragies","justification":""},{"idx":2,"correct":false,"proposition":"Hemarthrosis","justification":"Hemarthrosis is deep bleeding. It therefore evokes a pathology of coagulation."},{"idx":3,"correct":true,"proposition":"An epistaxis","justification":""},{"idx":4,"correct":true,"proposition":"A melena","justification":"Melena testifies to mucosal involvement, which is readily found in thrombocytopenia."}],"type":"dp"}
+{"_id":"annales-2020-dp-5-qi-4","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"On examination, you actually find purpura. What are the expected characteristics of purpura in this context? (one or more possible answers) ","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Painful","justification":""},{"idx":1,"correct":false,"proposition":"Necrotic","justification":""},{"idx":2,"correct":true,"proposition":"Petechial","justification":""},{"idx":3,"correct":false,"proposition":"Infiltrated","justification":""},{"idx":4,"correct":true,"proposition":"Associated with bruising","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-5-qi-5","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"What first-line exams will you request? (one or more possible answers)","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Complete blood count","justification":"We want to know hemoglobin. Be careful, the NFS does not provide information on the platelets (it is the NFS-P that counts the platelets!)."},{"idx":1,"correct":false,"proposition":"INR","justification":"Bleeding disorders are not suspected."},{"idx":2,"correct":false,"proposition":"TP, TCA, fibrinogen","justification":"Bleeding disorders are not suspected."},{"idx":3,"correct":false,"proposition":"D-dimer","justification":"We have no arguments for a potential DICV here."},{"idx":4,"correct":false,"proposition":"Reticulocytes","justification":"It will be asked if there is anemia."}],"type":"dp"}
+{"_id":"annales-2020-dp-5-qi-6","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"The CBC shows: red blood cells 2.24 T\/L, hemoglobin 76 g\/L, hematocrit 22.1%, MCV 98.7 fL, MCDC 34.4 g\/dL, leukocytes 1.3 G\/L, neutrophils 0.4 G\/L, lymphocytes 0.5 G\/L, monocytes 0.05 G\/L, blasts 0.35 G\/L, platelets 9 G\/L, reticulocytes 45 T\/L. Describe this NFS: ","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Neutropenia","justification":"neutrophils 0.4 G\/L when normal is > 1.5 G\/L"},{"idx":1,"correct":false,"proposition":"Hyperlymphocytosis","justification":"lymphocytes 0.5 G\/L when normal is > 1.5 G\/L"},{"idx":2,"correct":true,"proposition":"Thrombocytopenia","justification":"9 G\/L blisters with a normal > 150 G\/L"},{"idx":3,"correct":true,"proposition":"Normochrome anemia","justification":"Normochrome because CCMH between 32 and 36"},{"idx":4,"correct":false,"proposition":"Regenerative anemia","justification":"reticulocytes 45 T\/L while we speak of regenerative above 120-150."}],"type":"dp"}
+{"_id":"annales-2020-dp-5-qi-7","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"What diagnoses do you mention? (one or more possible answers) ","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Idiopathic bone marrow suppression","justification":""},{"idx":1,"correct":false,"proposition":"Aggressive lymphoma","justification":""},{"idx":2,"correct":false,"proposition":"Immunological thrombocytopenic purpura","justification":""},{"idx":3,"correct":true,"proposition":"Acute leukemia","justification":"The circulating blasts direct us directly to leukemia."},{"idx":4,"correct":false,"proposition":"Chronic myeloid leukemia","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-5-qi-8","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"You receive the hemostasis assessment. It shows: TP at 50%, TCA ratio 1.1, fibrinogen 0.88 g \/ l. How do you complete the hemostasis assessment? (one or more possible answers) ","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The determination of D-dimer","justification":"The TP is decreased, the TCA begins to increase, the fibrinogen is low 👉 red alert CIVD! The dosage of D-Dimer will allow us to base the diagnosis."},{"idx":1,"correct":false,"proposition":"The search for circulating anticoagulant","justification":""},{"idx":2,"correct":true,"proposition":"Determination of factor V","justification":"The TP is low, so factor VII is decreased. The determination of factor V will allow us to know if the decrease in factor VII comes from the liver (hepatocellular insufficiency) or from the synthesis of vitamin-dependent factors (X, IX, VII, II)."},{"idx":3,"correct":false,"proposition":"Anti-Xa activity","justification":""},{"idx":4,"correct":false,"proposition":"Determination of factor VIII","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-5-qi-9","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"You suspect acute myelogenous leukemia. You perform a myelogram. What are you waiting for? (one or more possible answers) ","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Poor marrow","justification":""},{"idx":1,"correct":true,"proposition":"The presence of more than 20% of myeloblasts","justification":""},{"idx":2,"correct":false,"proposition":"An increase in the number of myelocytes and metamyelocytes","justification":"Myelocytes and metamyelocytes are greatly reduced"},{"idx":3,"correct":true,"proposition":"Decreased or absent megakaryocytes","justification":""},{"idx":4,"correct":true,"proposition":"The presence of blasts with Auer bodies","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-5-qi-10","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"Mr. R. does have acute myelogenous leukemia. What should you do? (one or more possible answers)","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Emergency hospitalization","justification":""},{"idx":1,"correct":true,"proposition":"Protective Custody","justification":""},{"idx":2,"correct":true,"proposition":"A multidisciplinary consultation meeting to decide on therapeutic conduct","justification":""},{"idx":3,"correct":true,"proposition":"Perform an ad consultation","justification":""},{"idx":4,"correct":true,"proposition":"Apply for ALD","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-5-qi-11","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"Mr. R.'s file was presented in PCR, which offers him to participate in a randomized phase therapeutic protocol. He is given information with a consent form. Who should sign it? (one or more possible answers)","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The patient","justification":""},{"idx":1,"correct":true,"proposition":"The local investigating physician","justification":"There are two signatures: that of the patient and that of his investigator."},{"idx":2,"correct":false,"proposition":"The intern in charge of the patient","justification":""},{"idx":3,"correct":false,"proposition":"The support person","justification":""},{"idx":4,"correct":false,"proposition":"The pharmacist who dispenses the study products","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-5-qi-12","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"Treatment is started and he needs a red blood cell transfusion. What biological tests should be performed before transfusion? (one or more possible answers) ","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"ABO Rhesus Group","justification":""},{"idx":1,"correct":true,"proposition":"Rhesus-KEL phenotyping","justification":""},{"idx":2,"correct":true,"proposition":"Irregular agglutinin (RAI) testing","justification":""},{"idx":3,"correct":false,"proposition":"EBV Serology","justification":""},{"idx":4,"correct":false,"proposition":"CMV Serology","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-5-qi-13","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"Mr. R.'s uncle was infected during a transfusion in 1984. Mr. R. therefore wished to know what checks had been carried out on the red blood cells. Which of the following are true? (one or more possible answers) ","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The products are all leukocyte-free","justification":""},{"idx":1,"correct":false,"proposition":"The products are all irradiated","justification":"For the premature, for the patient in SCID (and not DICV), ..."},{"idx":2,"correct":true,"proposition":"Products are tested for HIV","justification":"HIV1 and 2"},{"idx":3,"correct":true,"proposition":"Products are tested for hepatitis B and C","justification":""},{"idx":4,"correct":false,"proposition":"Products are tested for CMV","justification":"The products are tested for HIV, HTLV, HCV, HBV, and syphilis."}],"type":"dp"}
+{"_id":"annales-2020-dp-5-qi-14","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"What are the legal provisions for transfusion? (one or more possible answers) ","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The nurse must verify the conformity of the product received","justification":""},{"idx":1,"correct":true,"proposition":"A doctor must be available quickly","justification":""},{"idx":2,"correct":false,"proposition":"Pellets must be transfused within one hour of arrival in the department","justification":"Within 6 hours"},{"idx":3,"correct":true,"proposition":"The nurse checks the identity match between the patient and the group card","justification":""},{"idx":4,"correct":true,"proposition":"The nurse checks the match between the group card and the cap pocket","justification":"The famous ultimate bedside test."}],"type":"dp"}
+{"_id":"annales-2020-dp-5-qi-15","context":"Mr R, 40, is an engineer and works a lot. He has smoked about a pack a day for 20 years, drinks occasionally and takes no medication. He consults today because for about a week he feels an unusual fatigue, and he has a lump in his tongue that bothers him.","enonce":"You prescribe the transfusion of 2 phenotyped red blood cells. The nurse performs the test on a test cardboard before the transfusion. The result is: {pos = presence of agglutinates, neg = absence of agglutinates}. Which propositions are true? (one or more possible answers)","item":"annales-2020-dp-5","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The patient is group A","justification":"The card contains anti-A antibodies. They react with the patient's 👉 blood it is group 🅰 ."},{"idx":1,"correct":false,"proposition":"The patient is Rhesus positive","justification":""},{"idx":2,"correct":false,"proposition":"The red blood cell group is identical to that of the patient","justification":""},{"idx":3,"correct":true,"proposition":"The red blood cell is compatible with the patient","justification":""},{"idx":4,"correct":true,"proposition":"The patient can be transfused without further prior examination","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-6-qi-1","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"In view of this clinical picture, which is (are) the diagnostic hypothesis(s) to evoke? ","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Fracture of the upper end of the femur","justification":"It would then be Garden 2."},{"idx":1,"correct":true,"proposition":"Fracture of the sacrum","justification":"The patient's symptoms are: foot levator\/lowering deficit, electrical pain + paresthesia of the right lower limb. These symptoms can be part of the nosological framework of damage to the L5-S1 roots, following a fracture of the sacrum or femur."},{"idx":2,"correct":false,"proposition":"Coxofemoral dislocation","justification":"Statement: 'The inspection does not find a vicious attitude of the lower limb.'"},{"idx":3,"correct":true,"proposition":"Adductor rupture","justification":"Trauma in abduction 👉 possible tearing of the adductors."},{"idx":4,"correct":false,"proposition":"Removal of the distal insertion of the iliopsoas","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-6-qi-2","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"Which exam(s) should I request in the first line?","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"X-ray of the front pelvis","justification":""},{"idx":1,"correct":true,"proposition":"X-ray of the thoracolumbar spine","justification":"She probably fell on her back and she has a pain in the lower 👉 limb lower lumbar vertebral fracture?"},{"idx":2,"correct":false,"proposition":"Thoraco-abdomino-pelvic CT scan","justification":""},{"idx":3,"correct":false,"proposition":"MRI of the pelvis","justification":""},{"idx":4,"correct":false,"proposition":"Ultrasound of the coxofemoral joint","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-6-qi-3","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"After a 2-hour decubitus rest in the emergency room, the patient wants to get back on her feet. She says she finds her right leg and foot still numb. She still can't lift or extend her foot. X-rays of the pelvis and thoracolumbar spine are performed. Given the clinical and radiological evidence available for this patient, what is the most likely diagnostic hypothesis? ","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A fracture of the spine","justification":"No fractures are visualized"},{"idx":1,"correct":false,"proposition":"A fracture of an ischiopubic branch","justification":"No fractures are visualized"},{"idx":2,"correct":false,"proposition":"A fracture of the upper end of the femur","justification":"No fractures are visualized"},{"idx":3,"correct":false,"proposition":"Damage to the obturator nerve","justification":"This nerve arises from the L2, L3 and L4 roots of the lumbar plexus. His sensory-motor innervation stops at the knee."},{"idx":4,"correct":true,"proposition":"Damage to the sciatic nerve","justification":"This corresponds to the symptomatology."}],"type":"dp"}
+{"_id":"annales-2020-dp-6-qi-4","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"On X-rays, no fractures were observed. Nerve damage has been suggested. The patient was discharged from the emergency room the same day and you will see her at home 3 days after her fall. On inspection, you notice visible skin signs in the following photo. On clinical examination, the patient complains of having a cotton leg and right foot and localized pain in the sole of the right foot. The right patellar reflex is present, the right Achilles absent while it is present on the left. In distality, there is difficulty raising and lowering the tip of the right foot. Motor testing during knee extension, abduction and right hip extension are possible against resistance and are normal. You notice weakness in the flexion of the leg on the right thigh. She has hypoaesthesia of her right leg. There is no vesico-sphincter disorder. Given the clinical evidence you have, what type(s) of neurological impairment(s) can you discuss? ","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Monoradiculopathy","justification":"The involvement of a single root (L5 or S1) does not explain all the symptomatology. The infringement is therefore more distorted."},{"idx":1,"correct":false,"proposition":"Polyradiculopathy","justification":"The involvement of several roots would give a more proximal symptomatology."},{"idx":2,"correct":true,"proposition":"Monotroncular involvement","justification":"Absent right Achilles reflex (carried by the root S1) + difficulty raising and lowering the tip of the foot (involvement of the fibular nerve, branch of the sciatic nerve, which comes from the root L5) = involvement of the sciatic nerve = monotroncular involvement."},{"idx":3,"correct":false,"proposition":"Incomplete paraparesis","justification":"Paraparesis is bilateral. However, the symptoms here are one-sided."},{"idx":4,"correct":false,"proposition":"Cauda equina syndrome","justification":"No sphincter bladder disorders, no proximal involvement, no arguments 😅."}],"type":"dp"}
+{"_id":"annales-2020-dp-6-qi-5","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"Three days after the trauma, in the context of sciatic monotroncular involvement, which examination would be most likely to change the management of this patient? (only one answer expected) ","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A lumbar spinal CT scan","justification":""},{"idx":1,"correct":false,"proposition":"Sacco-radiculography","justification":""},{"idx":2,"correct":false,"proposition":"A perineal electromyogram","justification":""},{"idx":3,"correct":false,"proposition":"An electromyogram of the lower limbs","justification":""},{"idx":4,"correct":true,"proposition":"An ultrasound of the right buttock and right thigh","justification":"The patient has a hematoma of the thigh, probably compressible 👉 we will try to see if this is really the case 😉"}],"type":"dp"}
+{"_id":"annales-2020-dp-6-qi-6","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"Ultrasound of the right buttock showed a hematoma that was evacuated because it compressed the sciatic nerve. You want to prescribe a right foot lifter-type technical aid. Which of the following regulatory elements for non-molded orthotics is(are) accurate:","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"They require a request for prior agreement","justification":""},{"idx":1,"correct":true,"proposition":"They are available from pharmacists","justification":""},{"idx":2,"correct":false,"proposition":"They are prescribed on a major appliance form.","justification":""},{"idx":3,"correct":true,"proposition":"They are prescribed on a simple prescription","justification":""},{"idx":4,"correct":false,"proposition":"They are fully reimbursed by the health insurance fund","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-6-qi-7","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"You decide to prescribe rehabilitation sessions on an outpatient basis at home. Among these elements, which is (are) mandatory on the prescription for the physiotherapist:","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Total number of sessions","justification":""},{"idx":1,"correct":true,"proposition":"The mention << at home>>","justification":""},{"idx":2,"correct":true,"proposition":"The region and\/or pathology to be treated","justification":""},{"idx":3,"correct":true,"proposition":"The mention << Masso-kinesitherapy>>","justification":""},{"idx":4,"correct":false,"proposition":"The physiotherapy technique used","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-6-qi-8","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"You follow your patient in regular consultation every month. Which of the following clinical or paraclinical elements is useful for monitoring recovery from this traumatic truncal nerve injury?","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Electromyogram","justification":"As for most peripheral nerve damage, the EMG will make it possible to follow the (potention of) evolution with the monitoring of the speeds \/ amplitudes of the impulse."},{"idx":1,"correct":true,"proposition":"Motor clinical testing","justification":""},{"idx":2,"correct":true,"proposition":"Sensory clinical testing","justification":""},{"idx":3,"correct":false,"proposition":"Ultrasound","justification":""},{"idx":4,"correct":false,"proposition":"Muscle electrostimulation","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-6-qi-9","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"You see the patient again in consultation 3 months after the initial trauma. She always has an abnormal gait. In the oscillating phase of walking on flat ground, the tip of the right foot is constantly lowered, it raises the knee higher than it does at the same phase on the left side. Which of these statements is (are) accurate?","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"This is a waddling approach","justification":""},{"idx":1,"correct":true,"proposition":"This is a steppage approach","justification":""},{"idx":2,"correct":false,"proposition":"This is a hot step","justification":""},{"idx":3,"correct":false,"proposition":"This is an earlier greeting","justification":""},{"idx":4,"correct":false,"proposition":"This is a mowing process","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-6-qi-10","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"The patient is increasingly anxious about walking due to her right sciatica neurological injury. She clings the tip of her right foot into a loose carpet at home, as she walked through a dark hallway. She stumbles and falls again. She can no longer support the right side because of pain. Here is the x-ray of the pelvis taken in the emergency room. What can you say from the X-ray? (one or more correct answers) ","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Right sacrarian-iliac disjunction","justification":""},{"idx":1,"correct":false,"proposition":"Garden 3 fracture of the right femoral neck","justification":""},{"idx":2,"correct":true,"proposition":"Right ischiopubic branch fracture","justification":""},{"idx":3,"correct":false,"proposition":"Right pertrochanteric fracture","justification":""},{"idx":4,"correct":false,"proposition":"Fracture of the right little trochanter","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-6-qi-11","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"Which of the various factors that may have contributed to this patient's fall, which do you consider to be an intrinsic factor(s) of falling? ","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Faulty lighting","justification":"Environmental factor"},{"idx":1,"correct":true,"proposition":"Damage to the sciatic nerve","justification":""},{"idx":2,"correct":false,"proposition":"The poorly fixed carpet","justification":"Environmental factor"},{"idx":3,"correct":true,"proposition":"Age-related macular degeneration","justification":""},{"idx":4,"correct":false,"proposition":"The orthosis (calf-plant lifter) ineffective","justification":"Walking disorder = predisposing factor"}],"type":"dp"}
+{"_id":"annales-2020-dp-6-qi-12","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"Which of the following is considered an activity limitation in this patient? ","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A decrease in the range of motion of the right hip","justification":"Impairment"},{"idx":1,"correct":false,"proposition":"Pain when walking","justification":"Impairment"},{"idx":2,"correct":true,"proposition":"Difficulty climbing stairs","justification":""},{"idx":3,"correct":false,"proposition":"A sensory disorder of the sole of the right foot","justification":"Impairment"},{"idx":4,"correct":true,"proposition":"Reduced walking performance","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-6-qi-13","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"You want to improve the patient's balance and walking disorders. Which of the following health professionals will contribute to the improvement of these symptoms?","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Orthoptist"},{"idx":1,"correct":false,"proposition":"Speech therapist"},{"idx":2,"correct":true,"proposition":"Podo-orthotist"},{"idx":3,"correct":true,"proposition":"Physiotherapist"},{"idx":4,"correct":true,"proposition":"Psychomotor therapist"}],"type":"dp"}
+{"_id":"annales-2020-dp-6-qi-14","context":"A 71-year-old patient is admitted to the emergency room following a fall from her height while shopping in a supermarket. She slipped on a vegetable with a forced abduction of the lower right limb responsible for a very violent pain. The patient was transported to the emergency department. She vomits during transport. She complains of no longer being able to raise and lower her foot, of having felt a stroke of electricity pain in the lower right limb to the foot, of feeling her right foot and leg \"cotton\". There was no loss of consciousness. The inspection does not find a vicious attitude of the lower limb. The patient has no treatment. His history includes an appendectomy, tonsillectomy, and colpo-suspension procedure in 2015. She also has ophthalmological follow-up for age-related macular degeneration. ","enonce":"Given the patient's age, which insurance organization(s) will contribute to the patient's care?","item":"annales-2020-dp-6","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Supplementary health fund","justification":""},{"idx":1,"correct":true,"proposition":"Caisse primaire d'assurance maladie","justification":""},{"idx":2,"correct":false,"proposition":"Communal social action services","justification":""},{"idx":3,"correct":false,"proposition":"Aid for the autonomy of the departmental council","justification":"APA is not insurance 😉"},{"idx":4,"correct":false,"proposition":"National Fund for Solidarity and Autonomy"}],"type":"dp"}
+{"_id":"annales-2020-dp-7-qi-1","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"Among the following acrosyndromes, and at this stage of the semiological description, which one (or which) is (are) compatible with the clinical picture reported by Mrs. X.? ","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Acrocyanosis","justification":""},{"idx":1,"correct":true,"proposition":"Raynaud's phenomenon","justification":""},{"idx":2,"correct":true,"proposition":"Erythermalgia","justification":""},{"idx":3,"correct":false,"proposition":"Chilblains","justification":""},{"idx":4,"correct":false,"proposition":"Digital necrosis","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-7-qi-2","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"She tells you that these episodes are clearly triggered by the cold, and presents you at the consultation a photograph taken during one of these episodes. With this new information, the possible diagnosis(s) is: ","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Secondary Raynaud's phenomenon","justification":""},{"idx":1,"correct":true,"proposition":"Raynaud's disease","justification":""},{"idx":2,"correct":false,"proposition":"Erythermalgia","justification":""},{"idx":3,"correct":false,"proposition":"Fine fibre neuropathy","justification":""},{"idx":4,"correct":false,"proposition":"Acrocyanosis","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-7-qi-3","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"You are diagnosed with Raynaud's phenomenon. What elements are to be looked for during the interrogation? (one or more expected answers) ","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"A cyanic phase","justification":""},{"idx":1,"correct":true,"proposition":"Damage to the toes","justification":""},{"idx":2,"correct":true,"proposition":"Thumb damage","justification":""},{"idx":3,"correct":true,"proposition":"A painful erythematous phase","justification":""},{"idx":4,"correct":false,"proposition":"Worsening when taking paracetamol","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-7-qi-4","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"On physical examination of the patient, you note: \n\n- whitening of the hand after compression of the ulnar and radial arteries and << pumping maneuvers >>, then obtaining a recoloration of the hand in 3 seconds following the relaxation of the ulnar artery; and in 4 seconds after the relaxation of the radial artery; \n\n- the absence of paresthesias of the fingers at the percussion of the anterior surface of the wrist or during the forced flexion of the wrist. \n\nThe patient's physical examination favours (one or more correct answers)","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"From a normal Allen maneuver","justification":"The cut-off is 7-10 seconds."},{"idx":1,"correct":false,"proposition":"Thrombosis of the radial artery","justification":""},{"idx":2,"correct":false,"proposition":"A positive Tinel sign","justification":""},{"idx":3,"correct":false,"proposition":"From compression of the median nerve to carpal tunnel","justification":""},{"idx":4,"correct":false,"proposition":"A positive Phalen sign","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-7-qi-5","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"What semiological element(s) are you looking for in favor of a secondary Raynaud's phenomenon? ","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Dry oral or ocular syndrome","justification":""},{"idx":1,"correct":true,"proposition":"Photosensitivity","justification":""},{"idx":2,"correct":true,"proposition":"Muscle pain","justification":""},{"idx":3,"correct":true,"proposition":"Scleroditactyly","justification":""},{"idx":4,"correct":true,"proposition":"Telangiectasias","justification":"Telangiectasias would be part of cutaneous scleroderma (CREST syndrome)."}],"type":"dp"}
+{"_id":"annales-2020-dp-7-qi-6","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"When questioned by Mrs. X., she explains that these symptoms began around the age of 30, and occur every winter. She has no notable personal history, but her sister and mother have the same type of clinical manifestations. Thumbs are spared. It does not describe any other symptoms. On physical examination, you do not find trophic disorder, sclerodactyly or telangiectasia, peripheral pulses are perceived in all 4 limbs, and you do not notice audible murmur on auscultation of arterial pathways. Which clinical element(s) is compatible with Raynaud's disease (essential Raynaud's phenomenon)? ","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The age of onset of symptoms","justification":"We start to ask ourselves questions after 35 years."},{"idx":1,"correct":true,"proposition":"Family history","justification":""},{"idx":2,"correct":true,"proposition":"Winter upsurge","justification":""},{"idx":3,"correct":true,"proposition":"Lack of thumb involvement","justification":""},{"idx":3,"correct":true,"proposition":"Bilateral Achievement","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-7-qi-7","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"In the clinical situation of Mrs. X., which additional examination(s) do you prescribe? ","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"X-ray of the spine from the front centered on C7","justification":""},{"idx":1,"correct":false,"proposition":"Chest x-ray from the front","justification":""},{"idx":2,"correct":false,"proposition":"Ultrasound-Doppler of the arteries of the upper limbs","justification":""},{"idx":3,"correct":false,"proposition":"Cryoglobulinemia detection","justification":""},{"idx":4,"correct":true,"proposition":"Antinuclear antibody testing","justification":"As well as a capillaroscopy."}],"type":"dp"}
+{"_id":"annales-2020-dp-7-qi-8","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"Antinuclear antibodies are 1\/80. You retain the diagnosis of essential Raynaud's phenomenon (Raynaud's disease) and propose symptomatic management. Five years later, Mrs. X. is referred to you by her doctor for a fever that has been evolving for 4 weeks. This fever is irregular, oscillating with a temperature of 37.9 ° C in the morning but higher in the evening, can rise up to 39 ° C and associated with sweating. Mrs. X. is tired, she has lost 2 kg since the beginning of this fever. She has no other symptoms. She lives in an urban setting, has never travelled abroad, and does not take any treatment. The clinical picture currently presented by the patient is compatible with: (one or more exact answers) ","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"A solid cancer","justification":""},{"idx":1,"correct":false,"proposition":"A familial Mediterranean fever","justification":"The picture does not stick: it is rather that of a teenager."},{"idx":2,"correct":true,"proposition":"An infectious disease","justification":""},{"idx":3,"correct":true,"proposition":"Lymphoma","justification":""},{"idx":4,"correct":true,"proposition":"Takayasu's disease","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-7-qi-9","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"In the clinical situation of the patient, what biological abnormality(s) would be suggestive of an inflammatory syndrome? ","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Increased albumin","justification":"Increase in all proteins except transport proteins: albumin, transferrin and transtyretrin."},{"idx":1,"correct":false,"proposition":"Decreased haptoglobin","justification":""},{"idx":2,"correct":true,"proposition":"Increased fibrinogen","justification":""},{"idx":3,"correct":true,"proposition":"Decreased transferrin","justification":""},{"idx":4,"correct":true,"proposition":"Increase in alpha2-globulins","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-7-qi-10","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"On physical examination of the patient in the supine position, you perceive a mass of the left hypochondrium lowering on deep inhalation. Which of the following proposals do you think is accurate given this new clinical element?","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"This clinical finding is common in a young, thin patient","justification":""},{"idx":1,"correct":false,"proposition":"This clinical finding makes an infectious cause less likely","justification":"Many infections can be accompanied by splenomegaly: mononucleosis syndrome (HIV, CMV, toxoplasmosis, ...), endocarditis, hepatitis, malaria, ..."},{"idx":2,"correct":false,"proposition":"This clinical finding makes an autoimmune cause less likely ","justification":"Lupus, sarcoidosis and rheumatoid arthritis (to name only the less rare) are often accompanied by splenomegaly."},{"idx":3,"correct":true,"proposition":"This clinical finding can be observed in cases of liver disease","justification":"👉 This is a sign of portal hypertension."},{"idx":4,"correct":true,"proposition":"This clinical finding should suggest a haemological pathy","justification":"Including lymphomas."}],"type":"dp"}
+{"_id":"annales-2020-dp-7-qi-11","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"On cardiac auscultation of Mrs. X., you perceive a systolic murmur at 2\/6. This heart murmur was not known until now. There is no associated diastolic murmur, heart sounds are regular, there are no signs of associated heart failure. You suspect infective endocarditis. What element(s) are you looking for to support your suspected diagnosis?","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Purpura of the lower limbs","justification":"Vascular pupura is an immunological manifestation"},{"idx":1,"correct":true,"proposition":"Purplish nodules of the pulp of the fingers ","justification":"This is called Osler's False Panaris (pathognomonic sign of infective endocarditis)."},{"idx":2,"correct":true,"proposition":"Proteinuria the urine strip","justification":""},{"idx":3,"correct":false,"proposition":"Distal paresthesias of the lower limbs","justification":""},{"idx":4,"correct":false,"proposition":"Red and painful eye","justification":"Roth's nodules can be observed at the back of the eye, but without affecting the anterior chamber."}],"type":"dp"}
+{"_id":"annales-2020-dp-7-qi-12","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"At this stage of the treatment, which examination(s) do you think are justified?","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Angiotensin-converting enzyme assay","justification":""},{"idx":1,"correct":false,"proposition":"PET-scanner"},{"idx":2,"correct":true,"proposition":"Blood"},{"idx":3,"correct":false,"proposition":"Antibodiesanti-pegtidescitrullinated (anti-CCP)","justification":""},{"idx":4,"correct":true,"proposition":"Transthoracic cardiac ultrasound","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-7-qi-13","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"Three blood cultures with aero-anaerobic cultures remain sterile, the good quality transthoracic cardiac ultrasound is normal, showing no vegetation image or significant valve abnormality. Which of the following proposals do you think is correct? ","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"The realization of a trans-esophageal cardiac ultrasound is justified","justification":"The description of ETT is very reassuring. Blood cultures are negative. It is lawful to stop there."},{"idx":1,"correct":true,"proposition":"The realization of a thoraco-abdomino-pelvic CT scan is justified","justification":""},{"idx":2,"correct":true,"proposition":"The realization of viral serologies (HIV and EBV) is justified","justification":""},{"idx":3,"correct":false,"proposition":"A therapeutic test with corticosteroids is justified","justification":""},{"idx":4,"correct":false,"proposition":"A therapeutic test with antibiotics is justified","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-7-qi-14","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"HIV serology is negative, and EBV serology supports ancient immunity. A thoraco-abdomino-pelvic CT scan shows supracentimetric mediastinal lymphadenopathy and splenomegaly. Which of the following tests do you think is the most relevant way to advance in the diagnostic investigation of the patient? (only one answer expected) ","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Search for anti-neutrophil cytoplasmic antibodies (ANCA)","justification":""},{"idx":1,"correct":false,"proposition":"lmmunophenotyping lymphocyte","justification":""},{"idx":2,"correct":false,"proposition":"Plasma LDH determination","justification":""},{"idx":3,"correct":false,"proposition":"Splenic biopsy","justification":"A spleen is not biopsied because there is too great a risk of bleeding."},{"idx":4,"correct":true,"proposition":"Mediastinal lymph node biopsy","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-7-qi-15","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"A diagnosis of diffuse large cell B-cell lymphoma is made by a lymph node biopsy performed by mediastinoscopy. An implantable chamber is placed and immunochemotherapy treatment with R-CHOP (rituximab - cyclophosphamide, hydroxydoxorubicin, vincristine and prednisone) is started. \n\nWhile the first 2 treatment cycles were uncomplicated, the patient ° presents on Day 10 of the 3rd treatment cycle a fever at 39 ° C with chills. You see her in an emergency consultation. Blood pressure is 130\/70 mmHg, heart rate is 95\/minute. The patient does not have a neurological disorder, the skin examination, especially with regard to the implantable chamber is normal, there is no obvious functional or physical respiratory, digestive or urinary sign. Your physical exam is normal. A blood count taken in town the same morning shows the following results: white blood cells 1.8 G\/L, hemoglobin 104 g\/L, mean corpuscular volume 85 fL, platelets 97 G\/L, leukocyte formula: neutrophils 0.4 G\/L eosinophilic polynuclear 0.1 G\/L, basophilic polynuclear 0.9 G\/L, lymphocytes 0.9 G\/L, monocytes 0.3 G\/L. What examination(s) do you perform before starting antibiotic therapy in your patient? ","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Aspergillary antigenemia","justification":""},{"idx":1,"correct":false,"proposition":"Blood smear looking for Jolly's bodies","justification":""},{"idx":2,"correct":true,"proposition":"Blood cultures on the periphery and on the central venous catheter","justification":""},{"idx":3,"correct":false,"proposition":"Chest X-ray","justification":""},{"idx":4,"correct":false,"proposition":"Thoraco-abdominal CT scan","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-7-qi-16","context":"Mrs. X., 32 years old, executive secretary, has been consulting you for finger pain for several months. These pains occur in episodes, last about ten minutes, and affect the fingers of the 2 hands. ","enonce":"Outpatient care is offered. Treatment with amoxicillin\/clavulanic acid + ciprofloxacin is started urgently. The fever disappears within 24 hours. Samples taken before the start of treatment remain sterile, and treatment is continued for 7 days. \n\nThree weeks later, the patient sees you again because of the onset of a fever at 39.5°C associated with the next rash. Which of the following may be present in your patient in case of drug reaction syndrome with eosinophilia and systemic signs (DRESS)? (one or more expected answers)","item":"annales-2020-dp-7","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Extensive skin detachment","justification":""},{"idx":1,"correct":true,"proposition":"eosinophilia> 1500\/mm3","justification":""},{"idx":2,"correct":true,"proposition":"elevation of transaminases with decrease of TP","justification":""},{"idx":3,"correct":true,"proposition":"acute renal failure","justification":""},{"idx":4,"correct":true,"proposition":"diffuse lymphadenopathy","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-8-qi-1","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"Which additional examination should be carried out first at this stage?","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Chest x-ray from the front","justification":""},{"idx":1,"correct":false,"proposition":"Echocardiography","justification":""},{"idx":2,"correct":false,"proposition":"Chest CT scan","justification":""},{"idx":3,"correct":true,"proposition":"Electrocardiogram","justification":""},{"idx":4,"correct":false,"proposition":"Arterial blood gas","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-8-qi-2","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"In the event of a myocardial infarction, which early life-threatening complication should you keep in mind as a priority during your initial management? ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Cardiogenic shock","justification":"It is less early, less serious, and less common than ventricular fibrillation."},{"idx":1,"correct":false,"proposition":"Septal rupture","justification":""},{"idx":2,"correct":false,"proposition":"Pericarditis","justification":""},{"idx":3,"correct":true,"proposition":"Ventricular fibrillation","justification":""},{"idx":4,"correct":false,"proposition":"Intraventricular thrombosis ","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-8-qi-3","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"The interrogation reveals that the pain is chronic, evolving crescendo for 3 months. The electrocardiogram performed immediately does not show an argument in favor of acute coronary syndrome. On physical examination, you find dyspnea at the slightest effort with appearance of edema of the bilateral lower limbs, a gain of 6 kg in 10 days as well as jugular turgor with hepatojugular reflux. The life constants are: BP 95\/65 mmHg, heart rate 112 beats\/min, OPS 98% ambient air, temperature 36.6 °C.  What are the two most likely diagnoses compatible with this clinical picture? ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Acute edema of the lung","justification":"There would be no signs of right heart failure (OMI, TJ, RHJ)."},{"idx":1,"correct":true,"proposition":"Pericardial tamponade","justification":""},{"idx":2,"correct":false,"proposition":"Myocardial infarction","justification":""},{"idx":3,"correct":true,"proposition":"Recurrent pulmonary embolisms","justification":""},{"idx":4,"correct":false,"proposition":"Aortic dissection","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-8-qi-4","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"By resuming your physical examination, the intern reports observing a paradoxical pulse. Which of the following proposals corresponds to the description of a paradoxical pulse? ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Pulse attenuated one out of two heartbeats","justification":""},{"idx":1,"correct":false,"proposition":"Expiratory pulse depression","justification":""},{"idx":2,"correct":true,"proposition":"Inspiratory pulse depression","justification":"Sign of tamponade."},{"idx":3,"correct":false,"proposition":"Pulse perception after the second heart sound","justification":""},{"idx":4,"correct":false,"proposition":"Increased pulse sitting leaning forward","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-8-qi-5","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"Inspiratory pulse depression confirms the paradoxical pulse. In this context, you ask for a front chest X-ray and echocardiography. What anomaly(s) do you identify on this shot taken in bed ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Right pleural effusion","justification":"We distinguish the pleural cul de sac."},{"idx":1,"correct":true,"proposition":"Cardiomegaly","justification":""},{"idx":2,"correct":false,"proposition":"Aspect of double aortic contour","justification":""},{"idx":3,"correct":false,"proposition":"Protrusion of the lower left arch of the cardiac silhouette","justification":"We asked a radiology PU-PH for his opinion on these two proposals. His answer: the protrusions of the heart arches correspond to cardiomegaly, but only when it is the heart that exceeds its usual size. We can not speak strictly of protrusion here, since the paradoxical pulse directs you to a pericardial effusion. "},{"idx":4,"correct":false,"proposition":"Protrusion of the lower right arch of the cardiac silhouette","justification":"We asked a radiology PU-PH for his opinion on these two proposals. His answer: the protrusions of the heart arches correspond to cardiomegaly, but only when it is the heart that exceeds its usual size. We can not speak strictly of protrusion here, since the paradoxical pulse directs you to a pericardial effusion. "}],"type":"dp"}
+{"_id":"annales-2020-dp-8-qi-6","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"On echocardiography, there is a circumferential pericardial effusion of great abundance with hemodynamic impact and a scalloped appearance of the serosa. You retain the diagnosis of pericardial tamponade. What element(s) is (are) involved in the pathophysiology of tamponade? ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Decreased systolic ejection volume of the left ventricle","justification":""},{"idx":1,"correct":true,"proposition":"Compression of the right ventricle","justification":""},{"idx":2,"correct":false,"proposition":"Compensatory bradycardia","justification":""},{"idx":3,"correct":true,"proposition":"Increased intrapericardial pressures","justification":""},{"idx":4,"correct":false,"proposition":"Shunt effect","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-8-qi-7","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"What is (are) the therapeutic measure(s) to be applied urgently in front of this tamponade? ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Pericardial drainage","justification":""},{"idx":1,"correct":false,"proposition":"Intravenous infusion of nitrates","justification":"It's not an OAP"},{"idx":2,"correct":false,"proposition":"Infusion of catecholamines (dobutamine or noradrenaline)","justification":""},{"idx":3,"correct":false,"proposition":"Volume depletion","justification":"It's not an OAP"},{"idx":4,"correct":false,"proposition":"Parenteral anticoagulation","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-8-qi-8","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"You transfer the patient for emergency drainage to the cardiac surgery block. 1,000 mL of bloody fluid was punctured. The pathologist identifies the presence of tumor cells of adenocarcinomatous nature. She was then admitted to intensive care. Which underlying primary tumor can you end up with a significant probability? (one or more correct answer(s)) ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Breast cancer","justification":""},{"idx":1,"correct":false,"proposition":"Melanoma","justification":"It is not adenocarcinoma"},{"idx":2,"correct":true,"proposition":"Lung cancer","justification":""},{"idx":3,"correct":false,"proposition":"Cavum cancer","justification":"It is not adenocarcinoma"},{"idx":4,"correct":false,"proposition":"Cervical cancer","justification":"It is not adenocarcinoma"}],"type":"dp"}
+{"_id":"annales-2020-dp-8-qi-9","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"A chest CT scan identifies in addition to neoplastic pericarditis in particular: a left hilar tumor mass extending to the apico-dorsal segment of the culmen associated with homolateral mediastinal adenomegaly, bilateral pleural effusion. What is the stage of the disease?","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"1","justification":""},{"idx":0,"correct":false,"proposition":"2","justification":""},{"idx":0,"correct":false,"proposition":"3a","justification":""},{"idx":0,"correct":false,"proposition":"3b","justification":""},{"idx":0,"correct":true,"proposition":"4","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-8-qi-10","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"In the case of primary stage IV bronchial adenocarcinoma, what extension assessment do you request in the absence of a new symptom (one or more correct response(s))?","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Brain CT scan","justification":""},{"idx":1,"correct":false,"proposition":"Abdominopelvic CT scan","justification":""},{"idx":2,"correct":false,"proposition":"Bone scintigraphy","justification":""},{"idx":3,"correct":false,"proposition":"Panendoscopy","justification":""},{"idx":4,"correct":true,"proposition":"None","justification":"The tumour is stage IV (disseminated). The extension assessment has no therapeutic impact."}],"type":"dp"}
+{"_id":"annales-2020-dp-8-qi-11","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"What is the reference oncological treatment for this stage IV bronchial cancer (one or more possible response(s))? ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Pneumo-pleuro-pericardectomy","justification":""},{"idx":1,"correct":false,"proposition":"Mediastinal radiation therapy","justification":""},{"idx":2,"correct":true,"proposition":"Systemic chemotherapy","justification":""},{"idx":3,"correct":false,"proposition":"Intrapericardial chemotherapy","justification":""},{"idx":4,"correct":true,"proposition":"Supportive care","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-8-qi-12","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"The general condition being preserved, you retain an indication of systemic treatment of metastatic first-line associated with palliative care. What will you look for on the pathological report of pericardial drainage fluid to guide the choice of systemic treatment (one or more possible answers)? ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"EGFR activating mutation","justification":""},{"idx":1,"correct":true,"proposition":"Expression de PDL1","justification":""},{"idx":2,"correct":true,"proposition":"Mutation de BRAF","justification":""},{"idx":3,"correct":true,"proposition":"Translocation of ALK","justification":""},{"idx":4,"correct":false,"proposition":"Nothing in particular, chemotherapy being based on a doublet of conventional drugs","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-8-qi-13","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"In the absence of targetable molecular alteration and expression of PDL1, you retain the indication of chemotherapy with carboplatin \/ paclitaxel. What is(s) the main expected side effect(s) of carboplatin of which you inform the patient? ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Asthenia","justification":"the 2"},{"idx":1,"correct":true,"proposition":"Stomatitis","justification":"the 2"},{"idx":2,"correct":true,"proposition":"Cytopenia","justification":"the 2"},{"idx":3,"correct":true,"proposition":"Peripheral neuropathy","justification":"paclitaxel"},{"idx":4,"correct":false,"proposition":"Hearing loss","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-8-qi-14","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"Finally the situation is complicated with a DICD not allowing to start chemotherapy. You move towards exclusive palliative care and decide to hospitalize the patient in a palliative care unit. Regarding palliative care units (PHUs), what is(are) the exact statement(s)? ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Their mission is to admit patients in end-of-life situations and who present a complex situation of care","justification":""},{"idx":1,"correct":false,"proposition":"The essential criterion for a patient to be admitted to USP is that his survival is estimated at less than three months","justification":""},{"idx":2,"correct":true,"proposition":"The main objective of a USP treatment is to improve the patient's quality of life","justification":""},{"idx":3,"correct":true,"proposition":"Chemotherapy treatments can be continued even while the patient is hospitalized in USP","justification":""},{"idx":4,"correct":false,"proposition":"The visit of children under 10 years old is not allowed in USP","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-8-qi-15","context":"A 55-year-old patient visits the emergency department for retrosternal chest pain. This pain radiates to the base of the neck and jaw. The anamnesis allows you to find in the personal history: active smoking at 10 pack-years and two caesarean sections","enonce":"After a few days of hospitalization in the palliative care unit, the situation, although precarious, stabilized and the patient expressed the wish to return home. What element(s) could jeopardize the organization of this return home? ","item":"annales-2020-dp-8","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Physical or moral exhaustion of loved ones","justification":""},{"idx":1,"correct":false,"proposition":"The need for 3 electric syringes","justification":""},{"idx":2,"correct":true,"proposition":"A refusal of the family to consider death at home","justification":""},{"idx":3,"correct":false,"proposition":"The need for morphine treatment at a high dosage","justification":""},{"idx":4,"correct":true,"proposition":"A lack of mobilization of the attending physician","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-9-qi-1","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"What therapeutic care do you offer for this diabetes? (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"800 kcal\/d and low-carbohydrate diet","justification":""},{"idx":1,"correct":true,"proposition":"Low-calorie diet (30% reduction in current intake) and low in fast sugars","justification":""},{"idx":2,"correct":false,"proposition":"Metformin therapy","justification":"We always start with hygiene measures in type 2 diabetes."},{"idx":3,"correct":false,"proposition":"Treatment with slow insulin and basal bolus","justification":""},{"idx":4,"correct":true,"proposition":"Physical activity","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-9-qi-2","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"You recover the following balance: creatinine at 130 μmol \/ L or a glomerular filtration rate CKD-PPE estimated at 52 ml \/ min \/ 1.73 m ^2 \nUrine strip: protein three cross, red blood cells three cross, leukocytes negative, nitrites negative, ketone bodies negative. What biological tests are needed at this stage? (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Renin aldosterone dosage","justification":""},{"idx":1,"correct":true,"proposition":"Cytobacteriological examination of urine","justification":""},{"idx":2,"correct":true,"proposition":"24-hour proteinuria","justification":""},{"idx":3,"correct":false,"proposition":"Anti-neutrophil cytoplasmic antibodies (ANCA)","justification":""},{"idx":4,"correct":false,"proposition":"Anti-PLA2R antibodies","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-9-qi-3","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"The results are as follows: \nECBU: red blood cells at 80,000\/ml, leukocytes< 1000\/ml, negative culture over 24 h. \n24-hour proteinuria: 2.5 g\/d composed of 70% albumin. \nWhat are the additional examinations to be carried out in the face of these anomalies? (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":" Fundus","justification":""},{"idx":1,"correct":true,"proposition":"Vesicorenal ultrasound with arterial Doppler","justification":""},{"idx":2,"correct":false,"proposition":"Accessory salivary gland biopsy","justification":""},{"idx":3,"correct":false,"proposition":"Renal MRI angiography","justification":""},{"idx":4,"correct":false,"proposition":"Uroscanner","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-9-qi-4","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"The fundus finds arterial stiffness with sign of crossing without further lesion. Renal Doppler ultrasound finds normal-sized kidneys without dilation of the pyelocalicial cavities. There is a simple kidney cyst of 1 cm on the right and one of 4 mm on the left. The Doppler analysis is not very contributory given the morphotype of the patient but the radiologist indicates that he does not find an indirect sign for significant renal arterial stenosis. \nThere is a 12 mm tissue-like image at the lower bladder bottom. In addition, despite the appropriate hygiene measures, diabetes control is unsatisfactory and you start treatment with metformin at a dose of 500 mg at a frequency of 3 times \/ day. Given these results, what can be the causes of this hematuria (one or more correct answers)?","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Polycystic kidney disease","justification":""},{"idx":1,"correct":false,"proposition":"Diabetic glomerular nephropathy","justification":"Hematuria is not found in diabetic glomerular nephropathy"},{"idx":2,"correct":true,"proposition":"lgA nephropathy","justification":""},{"idx":3,"correct":true,"proposition":"Urothelial tumour","justification":"The ultrasound imagining orients us somewhat."},{"idx":4,"correct":true,"proposition":"Extramembranous glomerulonephritis","justification":"GEM can be accompanied by hematuria"}],"type":"dp"}
+{"_id":"annales-2020-dp-9-qi-5","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"What tests are needed to explore this hematuria at this stage? (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Puncture kidney biopsy","justification":""},{"idx":1,"correct":true,"proposition":"Bladder fibroscopy","justification":""},{"idx":2,"correct":true,"proposition":"Urinary cytology on fresh urine with histopathological examination","justification":""},{"idx":3,"correct":true,"proposition":"Uroscanner","justification":""},{"idx":4,"correct":false,"proposition":"Ascending urethrocystography and voiding","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-9-qi-6","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"You decide to do urinary cytology and bladder fibroscopy. \nRegarding the possible realization of the uroscanner in your patient, which proposals are accurate (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"This examination is contraindicated in this patient","justification":""},{"idx":1,"correct":true,"proposition":"Metformin should be stopped on the day of the exam","justification":"It will be reintroduced on Day 2."},{"idx":2,"correct":false,"proposition":"Hydration by glucose solute is to be expected before the examination","justification":""},{"idx":3,"correct":true,"proposition":"Oral hydration is to be expected before the examination","justification":""},{"idx":4,"correct":false,"proposition":"There is a risk of acute interstitial nephritis","justification":"There is a risk of acute tubular necrosis."}],"type":"dp"}
+{"_id":"annales-2020-dp-9-qi-7","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"The uroscanner did not find any other urothelial lesions. Cystoscopy confirmed the existence of the polyp and a transurethral resection of the bladder polyp was performed. Anatomical pathology has shown that it is a low-grade urothelial carcinoma pTa. What is the exact proposal regarding his tumor? (an expected response) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"It is an invasive tumor infiltrating the muscle","justification":"From T2"},{"idx":1,"correct":false,"proposition":"This is carcinoma in situ","justification":"Tis"},{"idx":2,"correct":false,"proposition":"It is a tumor infiltrating the chorion","justification":"T1"},{"idx":3,"correct":true,"proposition":"It is a non-invasive papillary tumour","justification":""},{"idx":4,"correct":false,"proposition":"It is an epidermoid tumor","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-9-qi-8","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"In the absence of diabetic retinopathy, you decide to perform a kidney biopsy. The pathology report is as follows: \n8 mm renal cortical fragment containing 12 glomeruli including 2 sclerotic glomeruli. \nThe remaining 10 glomeruli exhibit nodular mesangial expansion with thickening of the basement membranes. \nThere is moderate arteriolar hyalinosis and interstitial fibrosis affecting 20% of the parenchyma of the biopsy. \nThe coloration by Congo red is negative. \nThe immunofluorescence study does not find significant deposits in the glomeruli. \nWhat is the most likely diagnosis (only one response expected) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Pauciimmune glomerulonephritis","justification":""},{"idx":1,"correct":false,"proposition":"Nephroangiosclerosis","justification":""},{"idx":2,"correct":false,"proposition":"Renal amyloidosis","justification":""},{"idx":3,"correct":true,"proposition":"Diabetic glomerulosclerosis","justification":""},{"idx":4,"correct":false,"proposition":"Membranoproliferative glomerulonephritis","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-9-qi-9","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"Your patient therefore has diabetic glomerulosclerosis. Its renal function stabilizes at 135 μmol\/I (DFG CKD EPI = 50 ml\/min\/1.73 m^22). What is the stage of his chronic kidney disease? (an expected response) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Stage 2","justification":""},{"idx":1,"correct":true,"proposition":"Stage 3A","justification":""},{"idx":2,"correct":false,"proposition":"Stage 1","justification":""},{"idx":3,"correct":false,"proposition":"Stage 3B","justification":""},{"idx":4,"correct":false,"proposition":"Stage 4","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-9-qi-10","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"What are the treatment targets in this patient at this stage? (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Proteinuria < 0.5 g\/24 hours","justification":""},{"idx":1,"correct":false,"proposition":"Negativation of hematuria","justification":"Hematuria is not a nephrological cause. It comes from his tumor."},{"idx":2,"correct":false,"proposition":"Blood pressure less than or equal to 120\/70 mmHg","justification":""},{"idx":3,"correct":false,"proposition":"Protein intake less than 0.6 g\/kg\/day","justification":""},{"idx":4,"correct":true,"proposition":"Salt intake close to 6 g\/24 hours","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-9-qi-11","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"Which of the following molecules can be prescribed as a first-line treatment for this patient for high blood pressure? (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"ACE inhibitor (ACE inhibitor)","justification":""},{"idx":1,"correct":true,"proposition":"Angiotensin II receptor antagonist (ARA2)","justification":""},{"idx":2,"correct":true,"proposition":"Angiotensin-thiazide receptor antagonist association","justification":"As a second line (amlodipine does not seem to be sufficient here)."},{"idx":3,"correct":true,"proposition":"Thiazide","justification":""},{"idx":4,"correct":false,"proposition":"Beta-blocker","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-9-qi-12","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"What therapies are possible in this patient to reduce cardiovascular risk? (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Clopidogrel","justification":""},{"idx":1,"correct":false,"proposition":"Effective anticoagulation","justification":""},{"idx":2,"correct":true,"proposition":"Statine","justification":""},{"idx":3,"correct":false,"proposition":"Allopurinol","justification":""},{"idx":4,"correct":false,"proposition":"Fibrate","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-9-qi-13","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"You have prescribed an angiotensin 2-thiazide receptor antagonist combination. You see him again in nephrology consultation two months later with a control biological assessment. He tells you that he was bedridden for a few days due to sciatica and that he took ibuprofen in self-medication. His blood pressure is 122\/73 mmHg, his heart rate is 82\/min. The electrocardiogram is normal. The blood test is as follows: Na 140 mmol\/L, K 5.5 mmol\/L, HCO3 21 mmol\/L, urea 18 mmol\/L, creatinine 212 μmol\/L. What are the factors that may have favored this acute renal failure (one or more exact responses) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Taking nonsteroidal anti-inflammatory drugs","justification":""},{"idx":1,"correct":false,"proposition":"Intracellular dehydration","justification":""},{"idx":2,"correct":true,"proposition":"Stenosis of the renal arteries","justification":""},{"idx":3,"correct":true,"proposition":"Treatment with angiotensin 2 and thiazide receptor antagonist","justification":""},{"idx":4,"correct":false,"proposition":"Metformin therapy","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-9-qi-14","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"What is your therapeutic attitude? (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Stop ibuprofen","justification":""},{"idx":1,"correct":true,"proposition":"Suspend angiotensin receptor antagonist 2","justification":""},{"idx":2,"correct":true,"proposition":"Suspend thiazide","justification":""},{"idx":3,"correct":false,"proposition":"Infusion of calcium gluconate ampoule IVD","justification":""},{"idx":4,"correct":false,"proposition":"Replace metformin with a sulphonylurea","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-9-qi-15","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"Her kidney function has improved thanks to your treatment and her serum creatinine has stabilized at 140 μmol\/L. You want to formally rule out stenosis of the renal arteries. What imaging tests are appropriate for this patient at this stage? (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Renal Doppler ultrasound","justification":"Been there, done that 🤷 ♂️"},{"idx":1,"correct":true,"proposition":"Renal angiography","justification":""},{"idx":2,"correct":false,"proposition":"Kidney scan with captopril test","justification":""},{"idx":3,"correct":true,"proposition":"Renal MRI angiography","justification":""},{"idx":4,"correct":false,"proposition":"Renal arteriography","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-9-qi-16","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"You have performed the following radiological examination. What are the exact proposals? (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Arrow 1 corresponds to the small intestine","justification":"It is rather the colon (the colonist is the most peripheral, if there is nothing on the right 👉 it is the colon 💩!)."},{"idx":1,"correct":true,"proposition":"Arrow 2 corresponds to the superior mesenteric vein","justification":""},{"idx":2,"correct":false,"proposition":"Arrow 3 corresponds to the pylorus","justification":"This is the pancreas. We are too low for the stomach."},{"idx":3,"correct":true,"proposition":"Arrow 4 corresponds to the right renal artery","justification":""},{"idx":4,"correct":true,"proposition":"The examination is done at an arterial phase","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-9-qi-17","context":"Mr. R, 58, is referred by his doctor to an endocrinologist before the discovery of diabetes. He is a tobacconist, rather sedentary. He has a history of active smoking at 45 pack-years and high blood pressure treated with amlodipine 5 mg for 5 years. He weighs 110 kg for 1m74 (BMI 36 kg\/m 2). His attending physician performed a blood test in front of the presence of asthenia and the result shows a fasting blood glucose of 2 g \/ L and a glycosylated hemoglobin of 8.5%. On clinical examination, his blood pressure is 170\/100 mmHg and his heart rate is 86\/min.","enonce":"The examination performed does not find significant stenosis. What advice do you give to your patient following this episode? (one or more correct answers) ","item":"annales-2020-dp-9","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Hydration by Vichy water 2 liters \/ day","justification":""},{"idx":1,"correct":true,"proposition":"Drinks of at least 1 liter\/day and suitable for 24-hour diuresis","justification":""},{"idx":2,"correct":true,"proposition":"Suspend angiotensin II receptor antagonist and thiazide in dehydration","justification":""},{"idx":3,"correct":false,"proposition":"Hydration by low mineralized water 2 liters \/ day","justification":""},{"idx":4,"correct":true,"proposition":"Formal contraindication to nonsteroidal anti-inflammatory drugs","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-10-qi-1","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"During your first consultation, what element(s) could guide you towards secondary obesity? ","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"His waistline","justification":""},{"idx":1,"correct":false,"proposition":"An acanthosis nigricans","justification":"Acanthosis nigricans is an aspecific sign of insulin resistance."},{"idx":2,"correct":true,"proposition":"Colored stretch marks from the root of the limbs","justification":"The famous 'purple stretch marks'."},{"idx":3,"correct":true,"proposition":"Edema of the lower limbs","justification":"Extracellular hyperhydration is not classic."},{"idx":4,"correct":true,"proposition":"Bruising of the forearms","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-10-qi-2","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"Waist circumference is measured at 102 cm and hip circumference at 128 cm. There is no acanthosis nigricans. You notice some stretch marks that the patient reports as related to her weight changes. His blood pressure is measured at 140\/84 mmHg. You prescribe an initial biological assessment. What will it include in the first intention? (one or more correct answers) ","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Free thyroxine","justification":""},{"idx":1,"correct":true,"proposition":"Fasting blood glucose","justification":""},{"idx":2,"correct":true,"proposition":"Lipid profile","justification":""},{"idx":3,"correct":true,"proposition":"Uricemia","justification":"Uricemia is part of the list of the systematic bio assessment in front of adult obesity in the college 🤷 ♂️ (page 357 of the 2021 edition)."},{"idx":4,"correct":false,"proposition":"24-hour urinary free cortisol","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-10-qi-3","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"You see her again a month later, the weight is the same and the patient explains that she is very interested in bariatric surgery and wants more information. Which proposal(s) is (are) accurate?","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"he sleep apnea syndrome is a contraindication to performing bariatric surgery","justification":""},{"idx":1,"correct":true,"proposition":"bariatric surgery has no indication when the BMI is less than 35 kg\/m2","justification":""},{"idx":2,"correct":false,"proposition":"Gastric banding is the technique that has shown the most effective","justification":""},{"idx":3,"correct":true,"proposition":"bariatric surgery cannot be performed until summer","justification":""},{"idx":4,"correct":true,"proposition":"Gastric bypass is responsible for weight loss through both restriction and malabsorption"}],"type":"dp"}
+{"_id":"annales-2020-dp-10-qi-5","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"It presents the results of the prescribed biological assessment: \n\nnatremia 138 mmol\/L; \n\nserum potassium level 3.2 mmol\/L; \n\nfasting blood glucose 1.16 g\/L (6.38 mmol\/L); \n\ntotal cholesterol 1.83 g\/L (N: 1.8-2.4); \n\ntriglycerides 2.58 g\/L (N: 0.7-1.5); \n\nHDL-cholesterol 0.40 g\/L (N: 0.45-0.90); \n\nLDL-cholesterol 0.91 g\/L (N: 0.6-1.6); \n\nAST 38 IU\/L (N < 20); ALT 65 IU\/L (N< 40). \n\nYou suspect Cushing's syndrome. What arguments point to this hypothesis? (one or more correct answers) ","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Blood sugar","justification":"Hyperglycemia can quite fit into the nosological framework of a common obesity and does not particularly point to a Cushing's syndrome."},{"idx":1,"correct":true,"proposition":"Potassium levels","justification":""},{"idx":2,"correct":false,"proposition":"Blood triglyceride levels","justification":"Hypertriglyceridemia can quite fit into the nosological framework of a common obesity and does not particularly point to a Cushing's syndrome."},{"idx":3,"correct":false,"proposition":"LDL-cholesterol levels","justification":"LDL-cholesterol levels are normal here."},{"idx":4,"correct":false,"proposition":"The level of transaminases","justification":"Cytolysis can quite fit into the nosological framework of a common obesity and does not particularly point to a Cushing's syndrome."}],"type":"dp"}
+{"_id":"annales-2020-dp-10-qi-6","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"What biological tests can you order to support your diagnostic hypothesis? (one or more correct answers) ","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Plasma cortisol at 8 o'clock","justification":""},{"idx":1,"correct":false,"proposition":"Plasma ACTH at 8 o'clock","justification":""},{"idx":2,"correct":false,"proposition":"Dosage of ACTH at midnight","justification":""},{"idx":3,"correct":true,"proposition":"Salivary cortisol at midnight","justification":""},{"idx":4,"correct":true,"proposition":"Dexamethasone minute brake test","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-10-qi-7","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"She tells you that she had an abdominal CT scan a few weeks ago because of abdominal pain. Two sections are reproduced below. Arrows with numbers represent anatomical structures. What is the exact answer(s)? ","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"1 represents the right adrenal","justification":""},{"idx":1,"correct":false,"proposition":"2 represents the transverse colon","justification":"Stomach (we are too high to see the transverse colon, we do not see small intestine or right\/left colon)."},{"idx":2,"correct":true,"proposition":"3 represents the spleen","justification":""},{"idx":3,"correct":false,"proposition":"4 represents the inferior vena cava","justification":"This is the aorta. The VCI is very prominent."},{"idx":4,"correct":true,"proposition":"5 represents the body of the pancreas","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-10-qi-8","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"The abdominal CT scan she performed was normal. The report you gave him gives the following results: salivary cortisol at midnight at 4 times normal. You have confirmed hypercortisolism by a 24-hour urine free cortisol assay with a result of 245 μg\/24 hours (N < 60). ACTH was dosed at 85 pg\/mL (N: 10-50). Which exam(s) can you now prescribe? ","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A metopirone test","justification":""},{"idx":1,"correct":true,"proposition":"A test at the CRH","justification":"The increase in cortisol after a CRH injection may confirm the pituitary origin of the hypersecretion (versus a paraneoplastic origin)."},{"idx":2,"correct":false,"proposition":"A dosage of delta 4 androstenedione","justification":""},{"idx":3,"correct":true,"proposition":"Pituitary MRI","justification":""},{"idx":4,"correct":false,"proposition":"Insulin hypoglycemia","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-10-qi-9","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"The CRH test shows a marked elevation of ACTH and cortisol. A section of the pituitary MRI you prescribed is reproduced below. Arrows with letters represent anatomical structures. Which structure(s) is correctly identified?","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A represents the third ventricle","justification":""},{"idx":1,"correct":true,"proposition":"B represents the optical chiasm","justification":""},{"idx":2,"correct":true,"proposition":"C represents pituitary adenoma","justification":""},{"idx":3,"correct":false,"proposition":"D represents the cavernous sinus","justification":""},{"idx":4,"correct":true,"proposition":"E represents the left internal carotid artery","justification":"She makes a little bow of families (that's why we see her twice 🥐)"}],"type":"dp"}
+{"_id":"annales-2020-dp-10-qi-10","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"In front of this pituitary macroadenoma, you want to complete your biological assessment. Which of the following proposals do you think is relevant to prescribe in this context? ","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"T4 assay","justification":"TSH + T4 assay"},{"idx":1,"correct":false,"proposition":"DHA Testing","justification":"DHA is secreted by the post-pituitary gland."},{"idx":2,"correct":false,"proposition":"GnRH testing","justification":""},{"idx":3,"correct":false,"proposition":"Dosage de la POMC","justification":"Almost never doses."},{"idx":4,"correct":true,"proposition":"Prolactin Determination","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-10-qi-11","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"The complementary balance shows: TSH 1.1 mIU\/L (N: 0.4-4); T4 14.8 pmol\/L (N: 8-20); estradiol 10 pg\/ml (N: 40-150); FSH 0, 1 IU\/L (N: 2-6); LH 0.5 IU\/L (N: 2-8); prolactin 30 μg\/L (N 25). What elements do you mention about this assessment? (one or more correct answers)","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Central hypothyroidism","justification":""},{"idx":1,"correct":true,"proposition":"Disconnection hyperprolactinemia","justification":"We speak of disconnection because < 100 μg\/L. Beyond that, we can talk about a prolactinoma."},{"idx":2,"correct":true,"proposition":"Hypogonadotropic hypogonadism","justification":""},{"idx":3,"correct":true,"proposition":"Pituitary anterior insufficiency","justification":"To check each time you have a deficiency of a lineage, it is an anterior pituitary insufficiency. Not to be confused with panhypopituitarism."},{"idx":4,"correct":false,"proposition":"Somatotropic deficiency","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-10-qi-12","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"To assess the impact of this Cushing's syndrome, you prescribe a bone densitometry, the results of which are reproduced below.\nWhich of the following is correct?","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"There is trabecular osteoporosis","justification":""},{"idx":1,"correct":true,"proposition":"The risk of spinal fracture (RA) is 73%","justification":""},{"idx":2,"correct":true,"proposition":"The disorders observed may be increased by estrogenic deficiency","justification":""},{"idx":3,"correct":true,"proposition":"The observed disorders may be increased by hyperprolactinemia","justification":""},{"idx":4,"correct":false,"proposition":"The observed disorders may be increased by obesity","justification":"Obesity does not lead to osteoporosis. It is even sometimes considered a protective factor: more fatty 👉 tissue more protection of the bone in case of trauma."}],"type":"dp"}
+{"_id":"annales-2020-dp-10-qi-13","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"You retain the diagnosis of corticotropic macro-adenoma and entrust the patient to your neurosurgeon colleague who practices his public activity at the CHU. He performed a rhinoseptal resection of this adenoma a few days later. There is no intraoperative incident and the neurosurgeon considers its excision satisfactory. In the recovery room, the patient quickly desaturates and presents a state of shock. Resuscitation measures are started immediately. However, the patient died a few minutes later. In this context, the neurosurgeon would like to perform a scientific autopsy to know the exact causes of death. What is (are) the procedure(s) to be carried out before this autopsy can be carried out ","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Querying the automated national register of refusals","justification":""},{"idx":1,"correct":false,"proposition":"Judicial report to the public prosecutor","justification":""},{"idx":2,"correct":true,"proposition":"Obtaining the approval of a pathologist to perform the autopsy","justification":""},{"idx":3,"correct":false,"proposition":"Search for an organ donor card in the patient","justification":""},{"idx":4,"correct":true,"proposition":"Interview with the family to seek the non-opposition of the patient during her lifetime","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-10-qi-14","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"The patient's family wishes to obtain a medical certificate. For what reason(s) can the doctor write it?","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"To find out the cause of death","justification":""},{"idx":1,"correct":true,"proposition":"To defend the memory of the deceased","justification":""},{"idx":2,"correct":false,"proposition":"To provide a comprehensive list of the patient's history","justification":""},{"idx":3,"correct":false,"proposition":"To rule out a suicide"},{"idx":4,"correct":true,"proposition":"To assert the rights of the family","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-10-qi-15","context":"Mrs. D, 28, consults in March because she wants to lose weight before the summer. Indeed, she has as her only antecedent a long-standing obesity, with a family history of obesity since her parents and two brothers are also affected. She has already tried several diets without much success and this time wants to be accompanied by a health professional. Clinically, weight is measured at 105 kg for a height of 170 cm, or a body mass index of 36.3 kg\/m 2. Waist circumference is measured at 102 cm and hip circumference at 128 cm. Over the year, his weight increased by 2 kg. She is nulliparous, amenorrhea for 6 months.","enonce":"The scientific autopsy performed reveals a massive proximal pulmonary embolism of both branches of the pulmonary artery. The family decides to initiate proceedings. What type(s) of responsibility can be engaged then?","item":"annales-2020-dp-10","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Criminal liability of the physician","justification":""},{"idx":1,"correct":false,"proposition":"No-fault liability of the physician","justification":"The patient died."},{"idx":2,"correct":true,"proposition":"Physician's civil liability","justification":"It will be engaged in case of detachable fault of the establishment."},{"idx":3,"correct":true,"proposition":"Administrative responsibility of the institution","justification":""},{"idx":4,"correct":true,"proposition":"Disciplinary responsibility of the physician","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-11-qi-1","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"Which diagnosis do you mention as a priority?","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Infantile hemangioma"},{"idx":1,"correct":false,"proposition":"Planar angioma"},{"idx":2,"correct":false,"proposition":"Syndrome de Kasabach-Merritt","justification":""},{"idx":3,"correct":false,"proposition":"Venous angioma"},{"idx":4,"correct":false,"proposition":"Lymphangioma"}],"type":"dp"}
+{"_id":"annales-2020-dp-11-qi-2","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"You suspect an infantile hemangioma. What is (are) the semiological element(s) that you will find at Romain's clinical examination? ","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A blowing character to auscultation","justification":""},{"idx":1,"correct":false,"proposition":"A shudder on palpation","justification":""},{"idx":2,"correct":true,"proposition":"An elastic consistency on palpation","justification":""},{"idx":3,"correct":false,"proposition":"A flat character on palpation","justification":""},{"idx":4,"correct":false,"proposition":"Hypertrophy of the hemiface on inspection","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-11-qi-3","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"Romain's parents ask you about the evolution and possible complications to expect from this infantile hemangioma. What do you say to them? (one or more correct answers) ","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A histological examination of the lesion makes it possible to better specify the chances of spontaneous involution","justification":""},{"idx":1,"correct":true,"proposition":"A growth phase may occur during the next few months","justification":""},{"idx":2,"correct":true,"proposition":"There is a risk of amblyopia","justification":"Given the location of this hemangioma, there is a risk that it covers the eye of little Theo and that this leads to functional 😥 amblyopia."},{"idx":3,"correct":true,"proposition":"The lesion may ulcerate","justification":""},{"idx":4,"correct":true,"proposition":"Complete disappearance without sequelae occurs in 50% of cases","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-11-qi-4","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"Parents are concerned about the risk of growth of the lesion and the risk of functional amblyopia by occlusion of the cleft palpebral, and ask if treatment will then be offered for Romain. What do you say to them? (one or more correct answers) ","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Treatment with propranolol will be offered","justification":""},{"idx":1,"correct":false,"proposition":"Pulsed dye laser treatment will be offered","justification":""},{"idx":2,"correct":false,"proposition":"Embolization treatment in interventional radiology will be proposed","justification":""},{"idx":3,"correct":false,"proposition":"Surgical treatment will be offered","justification":""},{"idx":4,"correct":false,"proposition":"Low molecular weight heparin therapy will be proposed","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-11-qi-5","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"Following a phase of growth of the lesion and the risk of impact on the palpebral opening, treatment with propranolol was put in place, allowing the complete disappearance of the lesion, without sequelae. You see Romain again in consultation at the age of 18 months because he has for several weeks an itchy skin involvement predominant on the face, and his sleep is disturbed. It is apyretic with conservation of the general condition. What semiological element(s) do you identify on this image?","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Xerosis","justification":"Hard to see in this photo."},{"idx":1,"correct":true,"proposition":"Erythema","justification":""},{"idx":2,"correct":false,"proposition":"Excoriations","justification":"Hard to see in this photo."},{"idx":3,"correct":false,"proposition":"Exanthema","justification":""},{"idx":4,"correct":false,"proposition":"Enanthemum","justification":"No mucous membrane is seen."}],"type":"dp"}
+{"_id":"annales-2020-dp-11-qi-6","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"Which of the following interrogation elements is relevant, if present, to support the diagnosis you suspect in Romain? ","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"History of asthma in Romain's father","justification":""},{"idx":1,"correct":false,"proposition":"History of psoriasis in Romain's mother","justification":"Psoriasis is not affected by atopic risk."},{"idx":2,"correct":true,"proposition":"Cow's milk protein allergy in Romain's brother","justification":""},{"idx":3,"correct":false,"proposition":"Recent pruritus in several family members","justification":"We are not looking for scabies but rather eczema (= atopic dermatitis) 😅"},{"idx":4,"correct":false,"proposition":"Frequent herpetic recurrences in Romain's mother","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-11-qi-7","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"You are diagnosed with atopic dermatitis motivating local corticosteroid therapy. What attitude(s) of prevention and prophylaxis do you put in place? ","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Adapt the vaccination schedule according to the evolution of the pathology","justification":""},{"idx":1,"correct":false,"proposition":"Prophylaxis of herpes superinfections with aciclovir","justification":""},{"idx":2,"correct":false,"proposition":"Prevention of superinfection by regular use of antiseptics","justification":""},{"idx":3,"correct":true,"proposition":"Daily use of fragrance-free emollients on body and face","justification":""},{"idx":4,"correct":true,"proposition":"Maintain a cool temperature in the room","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-11-qi-8","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"You see again urgently Romain 1 month later for a predominant rash on the trunk, appeared the night before, in a context of fever up to 39 ° C for 2 days, without alteration of the general condition. The temperature measured in the office is 37.2 ° C (last taken of paracetamol 24 hours ago). The clinical examination, apart from the skin examination, is unremarkable. What diagnosis(s) do you mention?","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Food allergies"},{"idx":1,"correct":false,"proposition":"Syndrome de Kaposi-Juliusberg","justification":""},{"idx":2,"correct":false,"proposition":"Measles"},{"idx":3,"correct":true,"proposition":"Infantile roseola"},{"idx":4,"correct":false,"proposition":"Epidemic megalerythema"}],"type":"dp"}
+{"_id":"annales-2020-dp-11-qi-9","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"You mention an infantile roseola (or sudden exanthema of the infant). What is the causative infectious agent? ","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Epstein-Barr virus"},{"idx":1,"correct":false,"proposition":"HSV-1 (herpes simplex virus)","justification":""},{"idx":2,"correct":false,"proposition":"Group A streptococcus"},{"idx":3,"correct":true,"proposition":"HHV-6 (herpes virus type 6)"},{"idx":4,"correct":false,"proposition":"Parvovirus B19"}],"type":"dp"}
+{"_id":"annales-2020-dp-11-qi-10","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"What recommendation(s) and\/or prescription(s) do you make to parents regarding the management of Romain roseola? ","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Eviction from the nursery for 10 days","justification":""},{"idx":1,"correct":false,"proposition":"Realization of a urine strip for proteinuria in 3 weeks","justification":""},{"idx":2,"correct":false,"proposition":"Prescription of ibuprofen","justification":""},{"idx":3,"correct":true,"proposition":"Prescription of paracetamol 15 mg\/kg every 4 to 6 hours, if fever rises","justification":""},{"idx":4,"correct":false,"proposition":"Prescription of a 17-butyrate hydrocortisone cream with 1 application per day on the body for 5 days","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-11-qi-11","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"After this intercurrent infectious episode, atopic dermatitis experienced a spontaneously favorable evolution. Now 5 years old and enrolled in kindergarten, he is brought to you by his parents for skin and hair lesions evolving for a few weeks. What diagnosis(s) do you evoke in front of these facial and scalp lesions? ","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Psoriasis"},{"idx":1,"correct":false,"proposition":"Seborrheic dermatitis"},{"idx":2,"correct":true,"proposition":"Dermatophyte infection"},{"idx":3,"correct":false,"proposition":"Trichotillomania"},{"idx":4,"correct":false,"proposition":"Plate pelade"}],"type":"dp"}
+{"_id":"annales-2020-dp-11-qi-12","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"Examination with Wood's lamp shows yellow-green fluorescence of the hairs in favor of microsporic ringworm. What do you do while waiting for the result of cultivation? (only one answer expected) ","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Therapeutic abstention","justification":""},{"idx":1,"correct":true,"proposition":"Prescription of local antifungals only","justification":"To be introduced after sampling to maximize their profitability."},{"idx":2,"correct":false,"proposition":"Prescription of systemic antifungals only","justification":""},{"idx":3,"correct":false,"proposition":"Prescription of local and systemic antifungals","justification":""},{"idx":4,"correct":false,"proposition":"Prescription of an antiseptic only","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-11-qi-13","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"In front of this microsporic ringworm with a very extensive alopecic plaque associated with several lesions of dermatophytosis of the hairless skin, you begin, without waiting for the results of the culture, a treatment combining local and systemic antifungals. Which systemic antifungal will you prescribe, as a first intention, to Romain? ","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Ketoconazole","justification":""},{"idx":1,"correct":false,"proposition":"ltraconazole","justification":""},{"idx":2,"correct":true,"proposition":"Griseofulvin","justification":"Treatment of moths of choice in children."},{"idx":3,"correct":false,"proposition":"Amphotericin B","justification":""},{"idx":4,"correct":false,"proposition":"Caspofungin","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-11-qi-14","context":"The parents of Romain, two weeks old, come to consult you urgently for the appearance for a few days of a lesion on the face of the child. The pregnancy proceeded without any particular problem, with a birth at 39 weeks, a birth weight of 3200 grams and a height of 50 cm. The infant is eating normally (artificial feeding) and there is no deterioration in general condition or fever. ","enonce":"The result of the culture comes back positive 3 weeks later to Microsporum canis. How could Romain be contaminated? ","item":"annales-2020-dp-11","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"By a dog","justification":""},{"idx":1,"correct":true,"proposition":"By a cat","justification":""},{"idx":2,"correct":false,"proposition":"By a land turtle","justification":""},{"idx":3,"correct":false,"proposition":"By a classmate","justification":""},{"idx":4,"correct":false,"proposition":"By the ground","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-12-qi-1","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"The doctor evokes the hypothesis of domestic violence. Which element(s) of the statement is (are) in favor of this hypothesis? ","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The presence of bruises of different ages","justification":""},{"idx":1,"correct":true,"proposition":"An incompatibility between a fall from stairs and the lesions observed","justification":""},{"idx":2,"correct":true,"proposition":"Emergency room admission time","justification":""},{"idx":3,"correct":false,"proposition":"The age of the patient","justification":""},{"idx":4,"correct":true,"proposition":"Sleep disorders","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-12-qi-2","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"Ms. X confirms that she was physically abused by her spouse the day before. She states that he took her by the neck, that she tried to protect herself by putting his hand in front of her face, but took several punches to the left hemiface. During this episode there was forced sex. Mrs. X came tonight because she was home alone, but does not plan to file a complaint because she does not want marital separation. The doctor considers whether to notify the public prosecutor. What criteria in the statement support compliance with the patient's choice not to file a complaint? (one or more correct answers) ","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The age of the patient","justification":""},{"idx":1,"correct":true,"proposition":"The absence of cognitive impairment","justification":""},{"idx":2,"correct":false,"proposition":"The presence of bruises of different ages","justification":""},{"idx":3,"correct":true,"proposition":"The absence of imminent danger at home","justification":""},{"idx":4,"correct":false,"proposition":"The occurrence of sexual violence associated with physical violence","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-12-qi-3","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"As Mrs. X is of age, without physical or psychological vulnerability, and not wishing to file a complaint, the doctor decided to respect her request and not to make a judicial report. What paraclinical element(s) can (s) be part of the management of this patient in the emergency room?","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Taking photographic photographs to document traumatic bodily injuries","justification":""},{"idx":1,"correct":false,"proposition":"Whole-body X-rays looking for fractures of different ages","justification":""},{"idx":2,"correct":false,"proposition":"A brain scan","justification":"Traumatic brain injury without loss of consciousness, without headache, without Master > 1 criteria."},{"idx":3,"correct":false,"proposition":"A fundus","justification":""},{"idx":4,"correct":false,"proposition":"A CPK blood test for muscle bruises","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-12-qi-4","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"Here is the picture of the arm of the outer face of the left arm. Which proposal(s) is true?","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"This lesion may correspond to the imprint of the pulp of a finger on the arm.","justification":""},{"idx":1,"correct":false,"proposition":"This lesion is recent in appearance","justification":""},{"idx":2,"correct":true,"proposition":"This lesion is older than those found in the left hemiface"},{"idx":3,"correct":false,"proposition":"This lesion may correspond to friction of the arm against a hard plane","justification":""},{"idx":4,"correct":true,"proposition":"This injury may correspond to a direct blow with an object on the arm.","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-12-qi-5","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"The doctor proposes to make a descriptive medical certificate. What should be mentioned? (one or more correct answers)","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The alleged date of the last episode of violence suffered by Ms X","justification":"In quotation marks"},{"idx":1,"correct":true,"proposition":"The objective account of the violence suffered by Mrs. X","justification":"In quotation marks"},{"idx":2,"correct":true,"proposition":"Description of all visible traumatic injuries","justification":""},{"idx":3,"correct":false,"proposition":"Ms. X's gynaecological history","justification":"This is irrelevant."},{"idx":4,"correct":true,"proposition":"The psychological symptoms resulting from the violence suffered by Ms X","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-12-qi-6","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"The psychological repercussions resulting from the violence must be investigated and mentioned on the descriptive medical certificate. What symptoms should the doctor look for when questioning Mrs. X to assess these repercussions and manage them? (one or more correct answers)","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Generalized anxiety"},{"idx":1,"correct":true,"proposition":"Nightmares"},{"idx":2,"correct":false,"proposition":"A quirk of contact"},{"idx":3,"correct":false,"proposition":"Auditory hallucinations","justification":""},{"idx":4,"correct":true,"proposition":"Avoidance pipes"}],"type":"dp"}
+{"_id":"annales-2020-dp-12-qi-7","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"During the interrogation, Mrs. X explains that she has been disturbed for several months in a disturbed sleep, with bad dreams where she sees herself pursued by a threatening shadow. She wakes up early, little rested, but cannot sleep during the day, always awake, jumping at the slightest noise. She gets angry more easily with her children. During the day, when she goes shopping, she makes detours to avoid passing in front of her husband's work and gym, to be sure not to cross him. Eventually, she ends up falling asleep, exhausted, in front of the television at night.\nMrs. X puts all this down to tensions in her work, and a recent family bereavement.\nShe explains that apart from a few episodes of slapping and forced sex, she has never been a victim of violence by her husband. When she hears about domestic violence, she doesn't feel concerned.\nAmong the elements of the interrogation, what symptoms are suggestive of post-traumatic stress disorder? (one or more correct answers)","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Sleep disorders"},{"idx":1,"correct":true,"proposition":"Avoidance lines"},{"idx":2,"correct":true,"proposition":"Denial of violence"},{"idx":3,"correct":true,"proposition":"Irritability"},{"idx":4,"correct":true,"proposition":"Hypervigilance"}],"type":"dp"}
+{"_id":"annales-2020-dp-12-qi-8","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"After a full information provided by the doctor, Mrs. X agrees to file a complaint. The doctor calls the judicial police officer on duty at the police station, who goes to the hospital to receive Ms. X's complaint. A gynaecological examination as well as medico-legal samples are requested on judicial requisition. These samples: ","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Are analyzed urgently at the hospital laboratory at the request of the medical examiner","justification":""},{"idx":1,"correct":true,"proposition":"Aim to highlight the DNA of the perpetrator","justification":""},{"idx":2,"correct":true,"proposition":"Must be duplicated","justification":""},{"idx":3,"correct":true,"proposition":"Are placed under seal by the judicial police officer","justification":""},{"idx":4,"correct":true,"proposition":"Are elements of the judicial procedure","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-12-qi-9","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"In the requisition, the judicial police officer asks you to set the ITT resulting from the violence. What does this acronym mean? ","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Total temporary incapacity","justification":"To avoid melting, we now speak of Total Functional Deficit (FTD)."},{"idx":1,"correct":true,"proposition":"Total incapacity for work","justification":""},{"idx":2,"correct":false,"proposition":"Temporary impossibility of work","justification":""},{"idx":3,"correct":false,"proposition":"Inability to work fully","justification":""},{"idx":4,"correct":false,"proposition":"Total impossibility of work","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-12-qi-10","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"What will be the purpose of the ITT (total incapacity for work) assessment for a victim of violence? (one or more correct answers) ","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"To classify the criminal offence of which she was a victim","justification":""},{"idx":1,"correct":false,"proposition":"Obtain emergency social housing more quickly if they leave home","justification":""},{"idx":2,"correct":false,"proposition":"To determine the duration of the prescribed absence from work following his injuries","justification":""},{"idx":3,"correct":true,"proposition":"To enable the magistrate to know the repercussions of the violence suffered on the state of health","justification":""},{"idx":4,"correct":true,"proposition":"To determine the competent court to try the perpetrator of the violence","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-12-qi-11","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"In the case of Ms. X, solicitor-client privilege: (one or more correct answers) ","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Is, unless otherwise specified, an obligation of the health professional","justification":""},{"idx":1,"correct":false,"proposition":"Allows the transmission of medical information about her to a police officer by telephone","justification":""},{"idx":2,"correct":false,"proposition":"Allows the transmission of medical information concerning her to her spouse","justification":""},{"idx":3,"correct":true,"proposition":"Persists in case of judicial requisition for all medical information that does not concern the questions of requisition","justification":""},{"idx":4,"correct":true,"proposition":"Allows the patient to be personally transmitted of the descriptive medical certificate upon discharge from the hospital if she does not wish to file a complaint","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-12-qi-12","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"Three weeks after Ms. X went to the emergency room, her husband, from whom she had separated, sent a letter to the hospital to complain about the medical certificate drawn up on requisition, which had been sent to her by her lawyer. He explains that the doctor did not put the story of the violence in the conditional and that he considers himself wrongly accused. In this context, what medical liability(s) can (s) be engaged? ","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Disciplinary responsibility","justification":""},{"idx":1,"correct":true,"proposition":"Civil liability","justification":"If the fault is detachable from the service."},{"idx":2,"correct":true,"proposition":"Criminal liability","justification":""},{"idx":3,"correct":true,"proposition":"Administrative responsibility","justification":""},{"idx":4,"correct":false,"proposition":"No-fault liability","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-12-qi-13","context":"Ms. X, a 37-year-old woman, presented to the emergency room of a public hospital at 10 p.m. for pain in her left cheekbone. She states that she accidentally fell down the stairs the day before, after tripping. She came to the hospital because she had time available for herself, her two children having gone to snow class, and her spouse also a few days in a professional seminar. On examination, the doctor notes several traumatic lesions: a reddish hematoma of the left cheekbone, a purplish bruise of the lower left eyelid, two centimetric reddish rounded bruises on the right lateral surface of the neck, a greenish bruise 4 cm in diameter on the right breast, three purplish bruises on the back of the right hand,  several yellowish bruises measuring between 1 and 2 cm on the inner and outer surfaces of both arms. The rest of the clinical examination is normal. This is a woman whose only history is a voluntary termination of pregnancy at the age of 18, and two pregnancies carried to term 12 and 8 years ago. She doesn't have usual treatment, but having been waking up at night for a few weeks, her best friend gave her a few zopiclone tablets.","enonce":"Eleven weeks later, Ms. X returned to the hospital because she knew she was pregnant as a result of the sexual violence she had reported during admission. She wishes to benefit from a voluntary termination of pregnancy. What is the real proposal(s)? ","item":"annales-2020-dp-12","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"The doctor is obliged to inform the police of this pregnancy","justification":""},{"idx":1,"correct":false,"proposition":"A voluntary medical termination of pregnancy may be proposed to Mrs. X","justification":""},{"idx":2,"correct":true,"proposition":"Two consultations are offered before the voluntary termination of pregnancy","justification":""},{"idx":3,"correct":false,"proposition":"The consent of Mrs X's spouse is required for the initiation of the procedure","justification":""},{"idx":4,"correct":false,"proposition":"The agreement of the public prosecutor is necessary for the initiation of the procedure","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-14-qi-1","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"What is (are) the criterion(s) of severity in this febrile child? ","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"His plainty cry","justification":""},{"idx":1,"correct":false,"proposition":"Age","justification":"The severity criteria for acute bronchiolitis in infants are: FR > 60\/min, HR > 180\/min, pauses in breathing, signs of struggle, SpO2 < 92%, anorexia."},{"idx":2,"correct":true,"proposition":"His heart rate","justification":""},{"idx":3,"correct":true,"proposition":"His breathing rate","justification":""},{"idx":4,"correct":false,"proposition":"Its skin recoloration time","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-14-qi-2","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"Given this clinical picture, what action do you take immediately? (only one answer expected)","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"NaCl bolus 0.9% 20 mL\/kg","justification":""},{"idx":1,"correct":false,"proposition":"Microbiological","justification":""},{"idx":2,"correct":false,"proposition":"Capillary blood glucose","justification":""},{"idx":3,"correct":false,"proposition":"Blood lonogram","justification":""},{"idx":4,"correct":false,"proposition":"Paracetamol 15 mg\/kg","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-14-qi-3","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"You have done vascular filling with 0.9% NaCl. Fifteen minutes later, his constants are as follows: heart rate 150 beats per minute, respiratory rate 70 per minute, temperature 39.1 ° C, skin recoloration time at 1 second. Chest auscultation regains a symmetrical vesicular murmur and a systolic murmur at 2\/6. Abdominal palpation is normal and otoscopy shows a hypervascularized right eardrum. The child is reactive, without hypotonia. \nWhat is the most likely diagnosis? ","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Purulent acute otitis media","justification":""},{"idx":1,"correct":false,"proposition":"Acute bronchiolitis","justification":""},{"idx":2,"correct":true,"proposition":"Acute pneumonia","justification":"High fever and lack of sibilants point more towards pneumonia."},{"idx":3,"correct":false,"proposition":"Infective endocarditis","justification":""},{"idx":4,"correct":false,"proposition":"Purulent meningitis","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-14-qi-4","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"You mention pneumococcal pneumonia. Which of the following is(s) in favor of this diagnosis?","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"The presence of nasopharyngitis","justification":""},{"idx":1,"correct":false,"proposition":"Age","justification":""},{"idx":2,"correct":true,"proposition":"The brutal beginning","justification":""},{"idx":3,"correct":false,"proposition":"A family storytelling","justification":""},{"idx":4,"correct":true,"proposition":"Poor food intake","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-14-qi-5","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"Chest X-ray shows systematized opacity of the right upper lobe with an aerial bronchogram. What is your assessment? ","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Blood ionogram","justification":""},{"idx":1,"correct":false,"proposition":"Legionella antigen in urine","justification":""},{"idx":2,"correct":true,"proposition":"Blood","justification":""},{"idx":3,"correct":false,"proposition":"Pneumococcal PCR on nasopharyngeal secretions","justification":""},{"idx":4,"correct":false,"proposition":"Hepatic test","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-14-qi-6","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"The blood test shows the following results: \n\nhemoglobin 115 g\/L, \n\nleukocytes 20 G\/L with 75% neutrophils, \n\nplatelets 400 G\/L, \n\nCRP 250 mg\/l, \n\nnatremia 129 mmol\/l, potassium 3.7 mmol\/l, \n\nurea 1.5 mmol\/l, creatinine 30 micromoles\/l. \n\nWhat pathophysiological elements are likely involved in this hyponatremia? (one or more correct answers)","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"A secretion of antidiuretic hormone","justification":""},{"idx":1,"correct":false,"proposition":"Adrenal insufficiency","justification":""},{"idx":2,"correct":true,"proposition":"Extracellular dehydration","justification":""},{"idx":3,"correct":false,"proposition":"An unsuitable infusion","justification":""},{"idx":4,"correct":false,"proposition":"Postpneumoccoccal glomerulonephritis","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-14-qi-7","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"You mention acute hyponatremia in a context of possible extracellular dehydration and DHA secretion complicating acute pneumonia. You set up an infusion adapted to ionic disorders. Which of the following offers do you offer antibiotic therapy?","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Intravenous amoxicillin","justification":""},{"idx":1,"correct":false,"proposition":"Dual therapy amoxicillin and macrolide","justification":""},{"idx":2,"correct":false,"proposition":"Oral amoxicillin","justification":""},{"idx":3,"correct":false,"proposition":"Intravenous cefotaxima","justification":""},{"idx":4,"correct":false,"proposition":"Macrolide per os","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-14-qi-8","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"You have started treatment with amoxicillin 90 mg\/kg\/day intravenously. 72 hours later, the infant remains feverish at 39.5°C.  You make an X-ray of the chest, interpret the images you see. ","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Shot made in the supine position","justification":""},{"idx":1,"correct":false,"proposition":"Strictly frontal impact","justification":""},{"idx":2,"correct":true,"proposition":"Presence of right fluid pleural effusion","justification":"We do not see a Damoiseau line because the child is lying, so the fluid is behind the pulmonary parenchyma and corresponds to the opacity of the lung."},{"idx":3,"correct":true,"proposition":"Presence of a right perihilar opacity","justification":""},{"idx":4,"correct":false,"proposition":"Abnormal enlargement of the upper mediastinum","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-14-qi-9","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"You carry the diagnosis of purulent pleurisy and adapt your antibiotic therapy. Which germ(s) should or should be covered by this antibiotic therapy?  ","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Staphylococcus aureus","justification":"Staphylococcus aureus infection is a common cause of purulent pleurisy."},{"idx":1,"correct":true,"proposition":"Streptococcus pneumoniae","justification":""},{"idx":2,"correct":true,"proposition":"Streptococcus pyogenes","justification":""},{"idx":3,"correct":false,"proposition":"Mycoplasma pneumoniae","justification":""},{"idx":4,"correct":false,"proposition":"Non-typeable Haemophilus","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-14-qi-10","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"The evolution is favorable under antibiotic therapy and the child is released from hospitalization 7 days later. He returned to the emergency room at 9 months of age for cough with fever at 38.2°C and difficulty breathing. The parents report that he presented with a febrile cough at the age of 7 months treated with oral antibiotic therapy. Weight gain between 6 and 9 months was 750 g. \n\nAt auscultation, you hear bilateral sibillants. You perform a chest X-ray that shows a systematized focus of the lower left lobe with aerial bronchogram. Faced with this recurrence, what is (are) the cause(s) to evoke? ","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Infant asthma","justification":"Infant asthma has a new definition: three episodes of wheezing dyspnea before 12 months, or two episodes + atopy (personal or family) before 12 months."},{"idx":1,"correct":true,"proposition":"Immunodeficiency","justification":""},{"idx":2,"correct":false,"proposition":"Intrabronchial foreign body","justification":""},{"idx":3,"correct":false,"proposition":"Congenital lung malformation","justification":""},{"idx":4,"correct":true,"proposition":"Cystic fibrosis","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-14-qi-11","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"What additional examination(s) do you do on this child? ","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Pulmonary function tests","justification":"He is a little young to blow into a tube 😇. EFRs, in fact, are not feasible for 3 to 6 years."},{"idx":1,"correct":true,"proposition":"Chest CT scan","justification":""},{"idx":2,"correct":false,"proposition":"Bronchial endoscopy","justification":""},{"idx":3,"correct":true,"proposition":"Immune investigation","justification":""},{"idx":4,"correct":false,"proposition":"PH-metry","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-14-qi-12","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"For the exploration of an immune deficiency, what is your first-line assessment?","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Weight determination of immunoglobulins","justification":""},{"idx":1,"correct":false,"proposition":"Lymphocyte phenotyping","justification":"Lymphocyte phenotyping detects membrane antigens (CD4, CD8, CD19, CD20, etc.) of lymphocytes to know if they are B, T, NK lymphocytes or other. It is, in this situation, a second-line examination."},{"idx":2,"correct":true,"proposition":"Post-vaccination serology"},{"idx":3,"correct":false,"proposition":"Exploring complement pathways","justification":""},{"idx":4,"correct":false,"proposition":"Determination of lgE"}],"type":"dp"}
+{"_id":"annales-2020-dp-14-qi-13","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"To explore the possibility of immune deficiency, the assessment includes a weight assay of immunoglobulins and post-vaccination serologies. The complete blood count was normal. Here are the results available at this stage: IgG 1 g\/L (N 3.3-6.2), lgA 0.2 g\/L (N 0.2-0.8), lgM 0.7 g\/L (0.5-1.3). Post-vaccination serologies reveal a defect in the production of specific antibodies. Which diagnosis do you think is most likely? (only one answer expected) ","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Common variable immunodeficiency","justification":""},{"idx":1,"correct":false,"proposition":"Combined immunodeficiency","justification":""},{"idx":2,"correct":false,"proposition":"Severe combined immunodeficiency","justification":""},{"idx":3,"correct":false,"proposition":"CD40 ligand deficiency","justification":""},{"idx":4,"correct":false,"proposition":"Absence of immune deficiency","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-14-qi-14","context":"You see a 4-month-old infant in the emergency room with a fever of 39.3°C.  He was born at term and had two bronchiolitis at 1 and 3 months. He was never breastfed. Parents report that he has been drinking less than half of his bottles for 24 hours and has vomited the last bottles. Clinical examination reveals a child with plaintive cry, rhinitis, his heart rate is 200 beats per minute, his respiratory rate is 70 per minute, his skin recoloration time is 2 seconds.","enonce":"You confirm the diagnosis of variable common immunodeficiency. As the vaccination schedule was respected until the age of 9 months, which vaccine(s) are indicated for this child for the next 6 months? ","item":"annales-2020-dp-14","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Measles-mumps-rubella","justification":"This vaccine is a live attenuated vaccine. It is contraindicated in case of immunosuppression."},{"idx":1,"correct":true,"proposition":"Polysaccharide pneumococcal","justification":""},{"idx":2,"correct":true,"proposition":"Meningococcal C","justification":""},{"idx":3,"correct":false,"proposition":"Chickenpox","justification":""},{"idx":4,"correct":true,"proposition":"Hepatitis B","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-15-qi-1","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"Which of the following proposals concerning the etiology of malaise would you provide discriminating information?","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The slow return to consciousness","justification":""},{"idx":1,"correct":false,"proposition":"Urine loss","justification":"Urine loss is not to be considered as a distinguishing element between the cardiac or epileptic origin of the malaise."},{"idx":2,"correct":false,"proposition":"Abdominal pain","justification":""},{"idx":3,"correct":false,"proposition":"The localization of hematomas of the limbs","justification":""},{"idx":3,"correct":true,"proposition":"The bite of the lateral edge of the tongue","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-15-qi-2","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"The dislocation is managed orthopedically. You hospitalize him for monitoring and assessment of the malaise. \n\nThe first night of hospitalization is difficult with constant wandering. The next morning, the staff noticed agitation and she tore off her drip. She does not see the point and wants to leave the institution. You notice a tremor of the upper limbs when maintaining the attitude. Objective examination (difficult given the patient's weak cooperation) seems normal except for an abolition of Achilles reflexes. The interrogation is difficult. Spontaneously, his speech is disjointed and incoherent. Which of the following suggestions regarding your diagnostic orientation on its current condition is compatible with this table?","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Pre delirium tremens","justification":""},{"idx":1,"correct":false,"proposition":"Status epilepticus","justification":""},{"idx":2,"correct":false,"proposition":"Parkinson's syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Amnesic ictus","justification":""},{"idx":3,"correct":true,"proposition":"Mental confusion","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-15-qi-3","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"What additional biological examination(s) are you performing at this stage to advance on the etiological context of this patient? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Complete blood count","justification":""},{"idx":1,"correct":true,"proposition":"Transaminases","justification":"An increase in OGT\/AST greater than that of TGP\/ALT may indicate chronic alcohol poisoning."},{"idx":2,"correct":true,"proposition":"Glycemia","justification":""},{"idx":3,"correct":true,"proposition":"Natremiah","justification":""},{"idx":4,"correct":false,"proposition":"Sedimentation rate","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-15-qi-4","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"The patient remains agitated and not very compliant. At this stage, biological results show MCV at 114μm (N < 100), TGO (aspartame aminotransferase) at 155 (N < 40), TGP (alanine aminotransferase) at 63 (N < 40), zero ethylemia and natremia at 134 mmol \/ L. What non-biological examination should be performed at this stage and during the day (only one response expected):","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Brain scan","justification":""},{"idx":1,"correct":false,"proposition":"Doppler echo of supra-aortic trunks","justification":""},{"idx":2,"correct":false,"proposition":"Electroencephalogram","justification":""},{"idx":3,"correct":false,"proposition":"Electroneuromyogram","justification":""},{"idx":4,"correct":false,"proposition":"Abdominal ultrasound","justification":"Abdominal ultrasound could give arguments for cirrhosis (bumpy liver, increased hepatic arrow, hyperechogenicity of the parenchyma, signs of portal hypertension) but, in front of the neurological signs and the context of fall (and potential head trauma), brain scan is more priority."}],"type":"dp"}
+{"_id":"annales-2020-dp-15-qi-5","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"The brain scan reveals diffuse and age-significant atrophy. An electroencephalogram is performed but is artefacted by the patient's movements and does not allow reliable interpretation. Which of the following therapeutic proposals are you putting in place at this stage? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Hydration based on glucose serum","justification":"Glucose increases the use of vitamin B1 and therefore the risk of Gayet-Wernicke encephalopathy. The patient must be hydrated with 0.9% NaCl."},{"idx":1,"correct":false,"proposition":"Anti-staphylococcal antibiotic therapy","justification":""},{"idx":2,"correct":false,"proposition":"Parenteral neuroleptic","justification":""},{"idx":3,"correct":true,"proposition":"Vitamin supplementation","justification":""},{"idx":4,"correct":true,"proposition":"Parenteral benzodiazepine","justification":"The patient appears to have symptoms of alcohol withdrawal, which therefore requires an emergency pharmacological prerisk. The patient's lack of compliance and the need for rehydration (so the patient will have a venous line in all cases) directs us towards a parenteral route."}],"type":"dp"}
+{"_id":"annales-2020-dp-15-qi-6","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"Concomitantly with the placement of the venous line, she presents a loss of consciousness with a period of generalized hypertonia and movements of the 4 limbs. She is receiving an intravenous benzodiazepine. The awakening is gradual. \n\nIn the hours that followed, confusion and agitation increased; The patient is covered in sweat, she makes incoherent remarks. Blood pressure is at 180\/110 mmHg. The heart rate is at 110\/min. The temperature is 38.5 °C.  The clinical examination is difficult but finds no obvious signs of neurological focus. \n\nWhich of the following diagnostic proposals is (are) accurate? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Acute delirious puff","justification":""},{"idx":1,"correct":false,"proposition":"Idiopathic generalized epilepsy","justification":""},{"idx":2,"correct":false,"proposition":"Toxic encephalopathy","justification":""},{"idx":3,"correct":true,"proposition":"Symptomatic seizure","justification":"The first part of the statement refers to an epileptic seizure secondary to alcohol withdrawal."},{"idx":4,"correct":true,"proposition":"Delirium tremens","justification":"Confusion, agitation, sweating, and incoherent remarks point to a delirium tremens."}],"type":"dp"}
+{"_id":"annales-2020-dp-15-qi-7","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"The clinical course under treatment is partially favorable. The patient is less agitated but confusion persists. You have contacted his doctor who confirms a significant and daily alcohol consumption, active smoking and social precariousness. By putting the patient in orthostatism, standing appears very unstable and walking is impossible without the help of a third party. During the examination, you notice multidirectional nystagmus and bilateral limitation of eye abduction. \n\nWhich of the following diagnostic hypotheses is compatible with the clinical picture? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Combined sclerosis of the spinal cord","justification":""},{"idx":1,"correct":false,"proposition":"Herpetic encephalitis","justification":""},{"idx":2,"correct":false,"proposition":"Paraneoplastic encephalitis","justification":""},{"idx":3,"correct":true,"proposition":"Gayet-Wernicke encephalopathy","justification":""},{"idx":4,"correct":false,"proposition":"Status epilepticus with confusional expression","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-15-qi-8","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"You mention the diagnosis of Gayet-Wernicke encephalopathy. In general, concerning the pathophysiological mechanism(s) that could explain or increase the symptoms of this pathology, which proposal(s) is(are) accurate? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Recent intake of isolated glucose serum","justification":""},{"idx":1,"correct":false,"proposition":"Presence of specific antibodies","justification":""},{"idx":2,"correct":true,"proposition":"Thiamine (vitamin B1) deficiency","justification":""},{"idx":3,"correct":false,"proposition":"Cobalamin (vitamin B12) deficiency","justification":""},{"idx":4,"correct":true,"proposition":"Inadequate dietary intake","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-15-qi-9","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"A brain MRI is performed. What is the sequence shown below? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Diffusion","justification":""},{"idx":1,"correct":false,"proposition":"T2 FLAIR","justification":"The gray matter (in the periphery) is white, the white matter (in medial) is gray 👉 It is a T2. The liquids are black 👉 It is a T2 FLAIR."},{"idx":2,"correct":false,"proposition":"T2","justification":"The median hypersignal that we see is not CSF, it is a hypersignal of the mammillary bodies that is readily found in deficiency encephalopathies."},{"idx":3,"correct":false,"proposition":"T1 with gadolinium injection","justification":""},{"idx":4,"correct":false,"proposition":"TOF (Time Of Flight) (Angio-MRI)","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-15-qi-10","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"Which of the following proposals for these MRIs is the visible anomaly? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Involvement of medial thalami","justification":"The thalami (plural of thalamus) are just opposite the lateral ventricles and the third ventricle. We can see in the first axial section that they are in hypersignal."},{"idx":1,"correct":true,"proposition":"Hypersignal in the periphery of the third ventricle","justification":"This hypersignal indicates an attack of the thalami."},{"idx":2,"correct":true,"proposition":"Periaqueductal hypersignal","justification":"The Sylvius aqueduct (synonymous with the midbrain aqueduct) is the small pipe that allows CSF communication between the third ventricle (located in the brain) and the fourth ventricle (located between the cerebellum and the brainstem). It is observed on the second axial section: it is in hypersignal (= we have a problem 😥)."},{"idx":3,"correct":false,"proposition":"Protuberantial lesion","justification":"The protuberance is synonymous with the bridge, which is the intermediate structure of the brainstem, making the link between the medulla elongata (synonym of myelencephalon) and the midbrain. We see it in the coronal cup: no hyper\/hypo-signal, everything is fine 👌"},{"idx":4,"correct":false,"proposition":"Damage to white matter","justification":"The white substance is gray on all cuts: there is no hypersignal, everything is fine 👌"}],"type":"dp"}
+{"_id":"annales-2020-dp-15-qi-11","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"You have been diagnosed with Gayet-Wernicke encephalopathy. Which of the following processing proposals are you putting in place now? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Hypertonic solution infusion","justification":""},{"idx":1,"correct":false,"proposition":"Intravenous antiepileptic drugs","justification":""},{"idx":2,"correct":false,"proposition":"Antiplatelet agent","justification":""},{"idx":3,"correct":true,"proposition":"Intravenous vitamin B1 supplementation","justification":"⚠ Single-answer question."},{"idx":4,"correct":false,"proposition":"Parenteral benzodiazepine","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-15-qi-12","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"The clinical course is favorable after three weeks of hospitalization. She therefore presented neurological complications of chronic alcoholism. Biological parameters are standardized except for MCV at 104 μm3. She seems to you to have understood the need for a definitive and total weaning. She keeps an abnormal neuropsychological assessment for her age with some visuospatial disorders, judgment and working memory. Walking is limited in terms of perimeter, cautious with widening of the lifting polygon, and tendency to hang the forefoot. \n\nWhat is (are) your hypothesis(s) to explain the gait disorders presented by this patient? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Apraxia when walking","justification":""},{"idx":1,"correct":true,"proposition":"Static cerebellar syndrome","justification":"Argued by the enlargement of the lift polygon"},{"idx":2,"correct":false,"proposition":"Lacunar syndrome","justification":""},{"idx":3,"correct":true,"proposition":"Polyneuropathy","justification":"Eroded by the deficit of foot lifters"},{"idx":4,"correct":false,"proposition":"Alcoholic myopathy","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-15-qi-13","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"You have been able to gather some social information: the patient lives alone, has no close relative, has been unemployed for 9 months. Regarding medico-social care, what approach(s) will you take? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Application for a disabled adult allowance","justification":"The AAH concerns people who have never worked, with a very high rate of disability. That is not the case here."},{"idx":1,"correct":true,"proposition":"Follow-up by the sector social worker","justification":""},{"idx":2,"correct":true,"proposition":"Proposal for a legal protection measure","justification":""},{"idx":3,"correct":false,"proposition":"Application for long-term illness with Social Security","justification":""},{"idx":4,"correct":false,"proposition":"Temporary suspension of driver's licence","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-15-qi-14","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"You have not heard from this patient again. Six months later, your psychiatrist colleague calls you about him. She is treated in psychiatric emergency for << delirium >>. You go to see it and see a seemingly normal reasoning but you are amazed by its familiarity. It presents significant memory disorders predominant on recent facts but also on older facts. The patient repeatedly asks you about her immediate future when you have already answered the same question several times. \n\nWhich of the following diagnostic proposals is accurate? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Acute drunkenness","justification":""},{"idx":1,"correct":true,"proposition":"Syndrome de Korsakoff","justification":""},{"idx":2,"correct":false,"proposition":"Paraneoplastic encephalitis","justification":""},{"idx":3,"correct":false,"proposition":"Vascular dementia","justification":""},{"idx":4,"correct":false,"proposition":"Status epilepticus with confusional expression","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-15-qi-15","context":"A 43-year-old woman is hospitalized in the emergency department for a painful left shoulder since an undetermined malaise with loss of consciousness. The discomfort would have occurred the day before. It is only in front of the functional impotence of the shoulder that she travels to the emergency room. The objective clinical examination a dislocation of the left shoulder. The general skin condition is poor with multiple dermabrasions and some hematomas on the limbs. His social situation is precarious. She says she doesn't take any medication. The ECG performed does not reveal any conduction anomaly.","enonce":"Which of the following propositions, are the semiological argument(s) that characterize Korsakoff syndrome? ","item":"annales-2020-dp-15","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Oculomotor disorders","justification":"Gayet-Wernicke encephalopathy"},{"idx":1,"correct":false,"proposition":"Spasmodic laughter and crying","justification":"Lacunar syndrome"},{"idx":2,"correct":true,"proposition":"Anterograde amnesia","justification":""},{"idx":3,"correct":true,"proposition":"Fabulations","justification":""},{"idx":4,"correct":true,"proposition":"False acknowledgements","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-16-qi-1","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"After quickly collecting the history and circumstances of occurrence of epistaxis, what is (are) the gesture (s) that you practice quickly? ","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Removal of clots by blowing their nose","justification":""},{"idx":1,"correct":true,"proposition":"Digital nasal compression for ten minutes","justification":""},{"idx":2,"correct":true,"proposition":"Establishment of a venous line","justification":""},{"idx":3,"correct":true,"proposition":"Blood group samples","justification":""},{"idx":4,"correct":true,"proposition":"Assessment of the presence of posterior hemorrhage by pharyngeal examination","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-16-qi-2","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"Regarding the vascularization of the nasal cavities, what is(are) the exact answer(s)?","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Branches of the internal carotid artery vascularize the lower turbinate","justification":""},{"idx":1,"correct":true,"proposition":"Vascularization comes mainly from the branches of the external carotid artery","justification":""},{"idx":2,"correct":true,"proposition":"The main artery is the sphenopalatine artery","justification":""},{"idx":3,"correct":false,"proposition":"The anterior ethmoidal artery is the terminal branch of the external carotid artery","justification":""},{"idx":4,"correct":true,"proposition":"The facial artery participates in the vascularization of the nasal cavities","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-16-qi-3","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"Which element(s) are you looking for during the interrogation?","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The unilateral or bilateral nature of the bleeding","justification":""},{"idx":1,"correct":true,"proposition":"A history of perforation of the nasal septum","justification":""},{"idx":2,"correct":true,"proposition":"The date and value of the last INR","justification":""},{"idx":3,"correct":true,"proposition":"The side with which epistaxis began","justification":""},{"idx":4,"correct":true,"proposition":"The abundance of epistaxis","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-16-qi-4","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"On clinical examination, the patient is pale and sweaty. The epistaxis is both anterior and posterior. Blood pressure is at 150\/95 mmHg with a regular heart rate at 124\/min. The temperature is 37.5 °C and oxygen saturation is 98%. \n\nWhat is (are) the element(s) in favor of severe epistaxis in this patient?","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Pallor","justification":""},{"idx":1,"correct":true,"proposition":"Sweats","justification":""},{"idx":2,"correct":true,"proposition":"Heart rate","justification":""},{"idx":3,"correct":false,"proposition":"Blood pressure","justification":""},{"idx":4,"correct":false,"proposition":"Previous bleeding","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-16-qi-5","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"You take a biological sample. Which biological parameter(s) are you asking for at this stage?","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Ferritin","justification":""},{"idx":1,"correct":true,"proposition":"Coagulation assessment including TP, INR, TCA","justification":""},{"idx":2,"correct":true,"proposition":"HR Group, RAI","justification":""},{"idx":3,"correct":true,"proposition":"Creatinine emia","justification":""},{"idx":4,"correct":true,"proposition":"Blood count","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-16-qi-6","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"A few minutes later, blood pressure is 85\/55 mmHg and heart rate is 130\/min. The patient has some mottling at the knees. What measure(s) do you propose at this stage? (one or more correct answers) ","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Find the cause of epistaxis","justification":"That is not the urgency here. The patient who appears to be in hemorrhagic shock must first be stabilized."},{"idx":1,"correct":true,"proposition":"Vascular filling by isotonic saline","justification":""},{"idx":2,"correct":true,"proposition":"Dry up the bleeding","justification":""},{"idx":3,"correct":false,"proposition":"Introducing intravenous noradrenaline as a continuous infusion","justification":""},{"idx":4,"correct":false,"proposition":"Perform an arteriogram","justification":"It is (almost) never possible to perform interventional radiology on an unstable patient."}],"type":"dp"}
+{"_id":"annales-2020-dp-16-qi-7","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"Vascular filling stabilized hemodynamics. The mottling has disappeared. You want to locate the origin of epistaxis at the level of the nasal cavities. \n\nWhat step(s) is necessary to localize the bleeding? (one or more correct answers) ","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"You blow the patient's nose to evacuate the clots","justification":"Step 1"},{"idx":1,"correct":true,"proposition":"You introduce a wick impregnated with local vasoconstrictor into the hemorrhagic nasal cavity","justification":"Step 2"},{"idx":2,"correct":true,"proposition":"You explore the nasal cavity as a whole","justification":"Step 3"},{"idx":3,"correct":false,"proposition":"You perform an arteriogram","justification":""},{"idx":4,"correct":false,"proposition":"You request a non-injected CT scan of the facial mass","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-16-qi-8","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"The patient is calm and after your endonasal examination you observe unilateral bleeding from the vascular spot. The INR is at 2.5. The rest of the balance sheet is pending. What is (are) the possible option(s) to stop the bleeding? ","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Installation of a double-balloon probe","justification":""},{"idx":1,"correct":true,"proposition":"Primary electrical cauterization of hemorrhagic vessels","justification":"This is a bleeding of the vascular 👉 task cauterization is to be done in first intention."},{"idx":2,"correct":true,"proposition":"Intravenous vitamin K prescription","justification":"The IV route is used here because it is a serious hemorrhage. The patient is not asymptomatic."},{"idx":3,"correct":false,"proposition":"The return home will be authorized in the absence of recurrence of the epistaxis after a surveillance of a few hours","justification":""},{"idx":4,"correct":false,"proposition":"Posterior dabbing with a greasy strand","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-16-qi-9","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"You performed cauterization of the vascular spot. Despite this, epistaxis persisted. You observe significant bleeding without being able to locate the exact origin. What is your immediate attitude? (only one exact answer) ","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Previous tamponade with a greasy strand or hemostatic swab","justification":""},{"idx":1,"correct":false,"proposition":"Anteroposterior buffering by double balloon probe","justification":"As a second intention."},{"idx":2,"correct":false,"proposition":"Discontinuation of vitamin K antagonists","justification":"It's been a long time since we stopped them (and even poured them out)."},{"idx":3,"correct":false,"proposition":"Ligation of ethmoidal arteries","justification":"As a last resort."},{"idx":4,"correct":false,"proposition":"Arteriography with selective embolization","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-16-qi-10","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"Despite a well-performed previous tamponade, you observe an early recurrence of epistaxis. What is your attitude? (only one exact answer) ","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Arteriography with selective embolization","justification":""},{"idx":1,"correct":false,"proposition":"Endonasal ligation of the sphenopalatine artery","justification":"Third intention"},{"idx":2,"correct":false,"proposition":"Anterior ethmoidal artery ligation","justification":"Last intention"},{"idx":3,"correct":false,"proposition":"Posterior ethmoidal artery ligation","justification":""},{"idx":4,"correct":true,"proposition":"Anteroposterior buffering by double balloon probe","justification":"This is the second step"}],"type":"dp"}
+{"_id":"annales-2020-dp-16-qi-11","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"You have managed to dry up epistaxis, and you decide to look for the etiology. Regarding epistaxis << >> symptom, which is (are) the diagnosis(s) that you can evoke? ","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Septal perforation","justification":""},{"idx":1,"correct":true,"proposition":"Complication of endonasal surgery","justification":""},{"idx":2,"correct":true,"proposition":"Tumor cause","justification":""},{"idx":3,"correct":false,"proposition":"Willebrand disease","justification":"It is necessary to differentiate epistaxis << symptom >> (local cause) from epistaxis << epiphenomenon >> (general cause) of which Willebrand and Rendu-Osler disease are part."},{"idx":4,"correct":false,"proposition":"Rendu-Osier disease","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-16-qi-12","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"Regarding epistaxis of general origin (<< epistaxis epiphenomenon >>), what is (are) the diagnosis (s) that you can evoke?","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Thrombopathy","justification":""},{"idx":1,"correct":false,"proposition":"Hemophilia","justification":"Bleeding disorders are expressed more by deep bleeding. In addition, the advanced age and the fact that it is a woman lead us to count this false proposition."},{"idx":2,"correct":true,"proposition":"Granulomatosis with polyangiitis","justification":""},{"idx":3,"correct":false,"proposition":"A rheumatoid purpura","justification":"She's a bit old 🤭"},{"idx":4,"correct":true,"proposition":"HTA at 250\/120 mmHg","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-16-qi-13","context":"A 72-year-old woman presents to the emergency room for an epistaxis that began a few days ago and has been interrupted several times. Since this morning, there is no possibility to stop it, bleeding persists. The patient is on anti-vitamin K therapy for complete arrhythmia by paroxysmal atrial fbrillation with regular INR check-ups.","enonce":"During the etiological assessment, you ask for a scan of the sinuses. On this coronal CT scan of the sinuses, which is (are) the exact proposal(s):","item":"annales-2020-dp-16","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"1 represents the right maxillary sinus","justification":""},{"idx":1,"correct":true,"proposition":"2 represents the lower right horn","justification":""},{"idx":2,"correct":true,"proposition":"3 represents the middle left horn","justification":""},{"idx":3,"correct":false,"proposition":"4 represents a tumor mass","justification":""},{"idx":4,"correct":false,"proposition":"4 represents the left posterior turbeach","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-17-qi-1","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"She consults for a rather dry cough evolving for 3 months. This cough has become very disabling and wakes her up at night. You mention the possibility of a cough with ACE inhibitors. Which of the following answers is correct about IEC cough?","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"It contraindicates angiotensin inhibitors II","justification":""},{"idx":1,"correct":false,"proposition":"It is dependent on the dose used","justification":""},{"idx":2,"correct":true,"proposition":"It can affect 5% or more of patients treated with ACE inhibitors","justification":""},{"idx":3,"correct":true,"proposition":"It is linked to a class effect","justification":""},{"idx":4,"correct":false,"proposition":"It usually occurs after an infectious episode","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-17-qi-2","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"You stop its ACE inhibitor and replace it with an angiotensin II inhibitor. The cough decreases in a few days and will disappear in less than 15 days. She has no sputum. The patient nevertheless complains of discomfort during exercise with a feeling of shortness of breath when walking flat quickly and when she climbs a slight slope, which she has noticed for several months when she returns home. You rate his dyspnea in his medical record by the chronic dyspnea scale of modified MRC (modified scale of Medical Research Counci\/). This scale assesses the impact of physical activity on dyspnea. What is the mMRC stage of this patient? ","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Stage 0","justification":"everything is fine we are oklm (important effort like everyone else, even Benzema)"},{"idx":1,"correct":true,"proposition":"Stage 1","justification":"a feeling of shortness of breath when walking flat fast and when climbing a slight slope = mMRC 1"},{"idx":2,"correct":false,"proposition":"Stage 2","justification":"a feeling of shortness of breath when walking with people of his age"},{"idx":3,"correct":false,"proposition":"Stage 3","justification":"a feeling of shortness of breath when walking after a few minutes flat"},{"idx":4,"correct":false,"proposition":"Stage 4","justification":"a feeling of shortness of breath preventing him from going out"}],"type":"dp"}
+{"_id":"annales-2020-dp-17-qi-3","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"You examine the patient. Cardiac auscultation is normal. Pulmonary auscultation finds a diffuse decrease in vesicular murmur without sibilant or crackling. Vocal vibrations are transmitted. The percussion of the thorax is generally tympanic. There is no sign of heart failure either right or left. She weighs 44 kg and is 1.55 m tall. Which clinical sign(s) testify to chest distention? ","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Hoover's sign","justification":"When the patient inhales, the transverse diameter (from right to left) of the chest decreases, whereas normally it should increase."},{"idx":1,"correct":false,"proposition":"Pilgrim edema","justification":""},{"idx":2,"correct":false,"proposition":"Cyanotic lips","justification":""},{"idx":3,"correct":true,"proposition":"Barrel thorax","justification":""},{"idx":4,"correct":false,"proposition":"Digital Hippocratism","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-17-qi-4","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"You carry out a spirometry of which here is the report. Which of the following proposal(s) is correct:","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"You can affirm the existence of an obstructive syndrome","justification":""},{"idx":1,"correct":true,"proposition":"CVL is higher than FVC","justification":""},{"idx":2,"correct":true,"proposition":"There is a significant lack of reversibility","justification":""},{"idx":3,"correct":false,"proposition":"You can claim chronic respiratory failure","justification":""},{"idx":4,"correct":false,"proposition":"You can affirm chest distension","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-17-qi-5","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"You complete the examinations with a front chest x-ray and more complete pulmonary function tests (RFS). Taking into account clinical history, clinical examination, imaging and EFRs, it is true that: ","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"You can claim chronic respiratory failure","justification":""},{"idx":1,"correct":true,"proposition":"You can affirm chest distension","justification":""},{"idx":2,"correct":true,"proposition":"You mention COPD"},{"idx":3,"correct":true,"proposition":"You suspect emphysema"},{"idx":4,"correct":false,"proposition":"You prescribe long-term oxygen therapy","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-17-qi-6","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"Given the clinical chest distension, chest distension on the lung X-ray with flattening of the diaphragmatic cupolas and EFRs you retain the diagnosis of COPD, probably in connection with emphysema, especially since there is an impairment of the diffusion. You explain to the patient that this disease is directly related to smoking and that quitting smoking will be essential. You assess his pharmacological\/nicotine dependence via the Fagerström test. \n\nWhich element(s) is (are) in favor of a strong pharmacological dependence? ","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Inhale smoke completely","justification":""},{"idx":1,"correct":false,"proposition":"Smoking brown tobacco","justification":""},{"idx":2,"correct":true,"proposition":"Smoking more than 30 cigarettes a day","justification":""},{"idx":3,"correct":true,"proposition":"Smoking a cigarette as soon as you wake up","justification":""},{"idx":4,"correct":false,"proposition":"Roll your own cigarettes","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-17-qi-7","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"After assessing her tobacco use and conducting a motivational interview, you find that the patient is motivated to quit smoking completely. She has a significant pharmacological dependence on nicotine with the first cigarette smoked within 5 minutes after waking up and again between 21 and 30 cigarettes a day. She does not consume other psychoactive products. You first prescribe nicotine substitutes in oral form. \n\nWhat is the exact proposal(s)? ","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"He will have to be prescribed a dose of 10 mg per day of nicotine","justification":""},{"idx":1,"correct":false,"proposition":"There is no support or refund","justification":""},{"idx":2,"correct":true,"proposition":"Nicotine substitutes have few side effects","justification":""},{"idx":3,"correct":true,"proposition":"Nicotine replacement therapy is more effective than placebo in cases of physical dependence","justification":""},{"idx":4,"correct":false,"proposition":"Nicotine substitutes are prescribed in his off-label case because of the cardiovascular history","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-17-qi-8","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"The patient will be able to quit smoking overnight, thanks in part to nicotine substitutes that you will be able to stop very gradually. She has never had an acute episode of worsening respiratory disease to date. As part of the treatment of his GCP0, what measure(s) to accompany the pharmacological management will you put in place? ","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Work stoppage","justification":""},{"idx":1,"correct":true,"proposition":"Physical Activity Tips","justification":""},{"idx":2,"correct":false,"proposition":"Low salt diet","justification":""},{"idx":3,"correct":false,"proposition":"Eviction of latex","justification":""},{"idx":4,"correct":true,"proposition":"Annual influenza and pneumococcal vaccinations","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-17-qi-9","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"You carry out the necessary vaccinations. Regarding his drug treatments, what is (are) the exact proposal(s)? ","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"You contraindicate its beta-blocker treatment","justification":"The patient does not have asthma."},{"idx":1,"correct":true,"proposition":"You prescribe a short-acting bronchodilator on demand","justification":"Every COPD patient should carry their BDCA."},{"idx":2,"correct":true,"proposition":"You prescribe a long-acting bronchodilator once or twice a day","justification":""},{"idx":3,"correct":false,"proposition":"You prescribe an inhaled corticosteroid as part of a fixed combination","justification":""},{"idx":4,"correct":false,"proposition":"You prescribe loop diuretics in moderate doses","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-17-qi-10","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"Despite the treatments put in place, the patient still has dyspnea of the mMRC stage. You are considering pulmonary rehabilitation. Regarding the latter, its effectiveness has been demonstrated on:","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Exercise capacity","justification":""},{"idx":1,"correct":true,"proposition":"Consumption of care","justification":""},{"idx":2,"correct":true,"proposition":"Dyspnea","justification":""},{"idx":3,"correct":true,"proposition":"Quality of life","justification":""},{"idx":4,"correct":false,"proposition":"FEV1","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-17-qi-11","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"The patient benefited greatly from pulmonary rehabilitation. Two years later, she is retired and comes to see you again in consultation because she feels much more breathless for a few days while her condition was quite stable until then. This increase in dyspnea is associated with the reappearance of a cough and purulent sputum. You suspect an exacerbation of COPD. What is the exact proposal(s)?","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"The majority of COPD exacerbations are infectious (viral, bacterial, or mixed)","justification":""},{"idx":1,"correct":false,"proposition":"The first exacerbation is usually not serious","justification":""},{"idx":2,"correct":true,"proposition":"The diagnosis of exacerbation is based on increased dyspnea, cough and\/or sputum","justification":""},{"idx":3,"correct":true,"proposition":"The main argument in favor of a bacterial infection is sputum purulence","justification":""},{"idx":4,"correct":false,"proposition":"The bacteria most often involved are Haemophilus influenzae, Pseudomonas aeruginosa and Moraxella catarrhalis","justification":"The 3 bacteria to know are: Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis. Pseudomonas aeruginosa is rarer, but more serious."}],"type":"dp"}
+{"_id":"annales-2020-dp-17-qi-12","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"She was admitted to the emergency room of the hospital. The nurse who takes care of her calls you because she is worried. You will find paradoxical abdominal breathing on clinical examination. Regarding paradoxical abdominal breathing, what is (are) the true proposition(s)? ","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"It is defined as the receding of the anterior wall of the abdomen during inspiration instead of the expected abdominal expansion","justification":""},{"idx":1,"correct":false,"proposition":"This is an active abdominal exhalation","justification":""},{"idx":2,"correct":true,"proposition":"Its presence indicates the absence of participation of the diaphragm in the ventilation which is then taken care of by the extra-diaphragmatic inspiratory muscles","justification":"That's what makes it serious."},{"idx":3,"correct":true,"proposition":"Its finding requires the admission of the patient to a structure where ventilatory assistance can be set up without delay.","justification":""},{"idx":4,"correct":true,"proposition":"Its presence raises fears of short-term failure","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-17-qi-13","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"You will immediately transfer the patient to respiratory intensive care. Chest X-ray does not find an infectious focus or pneumothorax. Analysis of blood gases in ambient air shows a pH of 7.35, a PaO at 50 mmHg and a PaCO2 at 48 mmHg, HCO3- at 26 mmol \/ L.  What treatment(s) will you put in place? ","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Nebulizing bronchodilators","justification":""},{"idx":1,"correct":true,"proposition":"Systematic antibiotic therapy","justification":"The patient shows signs of severity. This is an indication for antibiotic therapy."},{"idx":2,"correct":true,"proposition":"Chest physiotherapy","justification":"Chest physiotherapy is offered acutely in case of significant bronchial secretions."},{"idx":3,"correct":true,"proposition":"Oxygen therapy with a titrated oxygen flow rate to obtain a pulsed oxygen saturation (Sp02) between 88% and 92%","justification":""},{"idx":3,"correct":false,"proposition":"3-week systemic corticosteroid therapy","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-17-qi-14","context":"You see in consultation a 61-year-old woman, night nurse in a pulmonology department. She has a history of smoking started at the age of 18 and continued with a current consumption of more than one pack of 20 cigarettes a day. She has smoked the same amount for at least the last 25 years. 18 months ago, she developed chest pain that led to the discovery of coronary stenosis that required a stent. She had no medical follow-up prior to this episode. At this time, hypercholesterolemia and high blood pressure were also detected. Since then, she has been treated with an antiaggregant, a selective cardio-blocker, a statin and an ACE inhibitor.","enonce":"The evolution is favorable with the treatment implemented without the need for mechanical ventilation. She can be discharged from hospital 8 days later. She gradually returns to her usual state. You see her again 6 months later because she has just presented some sputum of pure blood during a coughing effort. She has no other symptoms elsewhere. His dyspnea is not increased. What is the exact proposal(s)? ","item":"annales-2020-dp-17","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"In the context of this patient, bronchial cancer must be ruled out until proven otherwise.","justification":""},{"idx":1,"correct":false,"proposition":"The administration of vitamin K should be carried out as a matter of urgency as a matter of principle","justification":""},{"idx":2,"correct":false,"proposition":"Taking the antiaggregant may be the cause of hemoptysis in this context of COPD","justification":"⚠ Recurrent pitfall: COPD is not a cause of hemoptysis."},{"idx":3,"correct":true,"proposition":"Chest computed tomography injected with arterial time is the key examination and will be performed if possible even before a bronchial endoscopy.","justification":""},{"idx":4,"correct":true,"proposition":"Despite good tolerance, management should be considered an emergency","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-18-qi-1","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"What element(s) are you looking for questioning about these pains to advance in your diagnostic hypotheses? ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Belt irradiation","justification":""},{"idx":1,"correct":false,"proposition":"Association with headache","justification":"He's a little too young for a Horton 😅"},{"idx":2,"correct":true,"proposition":"Decrease during meals","justification":""},{"idx":3,"correct":true,"proposition":"Acute or progressive affixing mode","justification":""},{"idx":4,"correct":false,"proposition":"Improvement through arm elevation","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-18-qi-2","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"In this patient, what etiology(s) should you mention? ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Bronchial cancer","justification":""},{"idx":1,"correct":true,"proposition":"Spondyloarthritis","justification":""},{"idx":2,"correct":false,"proposition":"Thoracic aorta dissection","justification":""},{"idx":3,"correct":false,"proposition":"Sequelae of vertebral growth epiphysitis","justification":""},{"idx":4,"correct":true,"proposition":"Duodenal ulcer","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-18-qi-3","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"The pain settled gradually over two months. Which element(s) point to the inflammatory nature of the pain in this patient? ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Persistence despite rest","justification":""},{"idx":1,"correct":true,"proposition":"Awakening at night","justification":""},{"idx":2,"correct":false,"proposition":"Difficulty falling asleep","justification":""},{"idx":3,"correct":false,"proposition":"Progressive worsening of pain","justification":""},{"idx":4,"correct":true,"proposition":"Improvement after one hour of activity in the morning","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-18-qi-4","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"On clinical examination, the pain is maximum on palpation of the spinous located opposite the two points of scapula. At what spinal level does this localization correspond? ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"1st thoracic vertebra","justification":""},{"idx":1,"correct":false,"proposition":"2nd thoracic vertebra"},{"idx":2,"correct":false,"proposition":"4th thoracic vertebra"},{"idx":3,"correct":true,"proposition":"7th thoracic vertebra","justification":"🤷‍♂️"},{"idx":4,"correct":false,"proposition":"11th thoracic vertebra","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-18-qi-5","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"In front of this inflammatory back pain located at the level of the 7th thoracic vertebra, what are you looking for in priority at the clinical examination? (one or more correct answers)","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Sign of Lasègue","justification":""},{"idx":1,"correct":true,"proposition":"Hypoaesthesia band"},{"idx":2,"correct":true,"proposition":"Abnormality of spine statics"},{"idx":3,"correct":true,"proposition":"Hyperthermia","justification":""},{"idx":4,"correct":false,"proposition":"Sign of Hoffman","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-18-qi-6","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"What exam(s) do you prescribe in the first line for this patient? ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"D-dimer","justification":""},{"idx":0,"correct":true,"proposition":"CRP","justification":""},{"idx":0,"correct":true,"proposition":"Complete blood count","justification":""},{"idx":0,"correct":false,"proposition":"TSH","justification":""},{"idx":0,"correct":false,"proposition":"PSA","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-18-qi-7","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"There is no inflammatory syndrome and the CBC is without abnormalities. A systematic ECG is normal. Why do you decide to do imaging tests? ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"The duration of symptom evolution","justification":"< 3 months"},{"idx":1,"correct":false,"proposition":"The age of the patient","justification":""},{"idx":2,"correct":true,"proposition":"The localization of pain","justification":""},{"idx":3,"correct":true,"proposition":"The schedule of pain","justification":""},{"idx":4,"correct":false,"proposition":"History of ulcer","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-18-qi-8","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"In this patient with inflammatory back pain with a normal biological assessment, which imaging examination seems most relevant to you at this stage? (only one answer expected) ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Chest X-ray","justification":""},{"idx":1,"correct":false,"proposition":"Cardiac ultrasound","justification":""},{"idx":2,"correct":false,"proposition":"Thoraco-abdomino-pelvic CT scan","justification":""},{"idx":3,"correct":true,"proposition":"Spinal MRI","justification":""},{"idx":4,"correct":false,"proposition":"Bone scintigraphy","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-18-qi-9","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"MRI of the entire spine performed quickly is normal. At the follow-up consultation one month later, the back pain gradually and spontaneously improved within a month. The patient makes an appointment with you three months later because he has had pain in his right knee for 2 days. What are you looking for on the physical exam? (one or more correct answers) ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Clinostatism","justification":""},{"idx":1,"correct":true,"proposition":"A knee injury","justification":""},{"idx":2,"correct":true,"proposition":"A patellar shock","justification":""},{"idx":3,"correct":false,"proposition":"A plantar skin reflex","justification":""},{"idx":4,"correct":true,"proposition":"Pain of the lateral edge of the knee during its extension (sign of the windshield wiper)","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-18-qi-10","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"There is patellar shock of the right knee. The patient has a temperature of 37.3 °C. You are wondering about performing a knee puncture. What is the true statement? ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"It is necessary to puncture the knee because there is an effusion","justification":""},{"idx":1,"correct":false,"proposition":"Do not puncture the knee because the pain has been evolving for less than 7 days","justification":""},{"idx":2,"correct":false,"proposition":"Do not puncture the knee because the temperature is normal","justification":""},{"idx":3,"correct":false,"proposition":"Do not puncture the knee because the patient is young","justification":""},{"idx":4,"correct":false,"proposition":"Do not puncture the knee because there is a risk of infecting the knee","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-18-qi-11","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"You decide to perform a joint puncture of the right knee. Which statement(s) is the correct statement(s)?","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"The patient must be seated","justification":""},{"idx":1,"correct":true,"proposition":"The procedure requires an antiseptic skin preparation","justification":""},{"idx":2,"correct":false,"proposition":"Prophylactic antibiotic therapy is needed","justification":""},{"idx":3,"correct":true,"proposition":"Cytological examination of the fluid is essential","justification":""},{"idx":4,"correct":false,"proposition":"Written consent from the patient must be obtained prior to the procedure","justification":"There are very few actions that require written consent. Punctures are not part of it (except genetic test)."}],"type":"dp"}
+{"_id":"annales-2020-dp-18-qi-12","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"The joint puncture fluid has 5500\/mm3 leukocytes. Germs are not found on direct examination or after cultivation. There are no microcrystals.\nWhich etiology(ies) is(are) the most likely?","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"A flare-up of osteoarthritis"},{"idx":1,"correct":false,"proposition":"One drop"},{"idx":2,"correct":true,"proposition":"Spondyloarthritis"},{"idx":3,"correct":false,"proposition":"Lupus"},{"idx":4,"correct":false,"proposition":"Osteonecrosis"}],"type":"dp"}
+{"_id":"annales-2020-dp-18-qi-13","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"You suspect spondyloarthritis. What are you doing to support this diagnosis? (one or more correct answers) ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":true,"proposition":"Search for a rocking fessalgia","justification":""},{"idx":1,"correct":true,"proposition":"Search for heel pain","justification":""},{"idx":2,"correct":true,"proposition":"Search for familial psoriasis","justification":""},{"idx":3,"correct":true,"proposition":"Looking for a history of finger in << sausage>>","justification":""},{"idx":4,"correct":false,"proposition":"Conducting an NSAID test","justification":"Ulcer history makes prescribing NSAIDs somewhat annoying 🤭"}],"type":"dp"}
+{"_id":"annales-2020-dp-18-qi-14","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"The search for the HLA B27 gene is positive. The patient is worried and asks you questions. What do you say to him? (one or more correct answers) ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"The presence of HLA B27 in the blood is variable over the course of life","justification":"Either the protein is there or it is not."},{"idx":1,"correct":false,"proposition":"The presence of HLA B27 requires the protection of your partner during sexual intercourse","justification":""},{"idx":2,"correct":false,"proposition":"You have to do the research in your children","justification":""},{"idx":3,"correct":true,"proposition":"HLA B27 is present in more than 90% of patients with ankylosing spondylitis","justification":""},{"idx":4,"correct":true,"proposition":"The vast majority of HLA B27+ subjects will never have spondyloarthritis","justification":""}],"type":"dp"}
+{"_id":"annales-2020-dp-18-qi-15","context":"A 37-year-old patient, a mechanic, has been suffering from mid-back pain for 2 months. He has difficulty falling asleep and the pain wakes him up in the second part of the night. The pain improves after an hour of activity in the morning while lying down rest does not relieve it. His history includes: high blood pressure, active smoking at 20 packs-year, a perforated gastric ulcer two years ago, penicillin allergy and childhood eczema. Until then, he had been running regularly, twice an hour a week.","enonce":"The patient asks you for advice regarding his long-term management. What measure(s) do you recommend? ","item":"annales-2020-dp-18","matiere":"annales-2020","propositions":[{"idx":0,"correct":false,"proposition":"Gluten-free diet","justification":""},{"idx":1,"correct":true,"proposition":"Regular physical activity","justification":""},{"idx":2,"correct":true,"proposition":"Smoking cessation","justification":""},{"idx":3,"correct":false,"proposition":"Nonsteroidal anti-inflammatory drugs for flare-ups","justification":"He cannot be recommended NSAIDs per se because of his history of ulcer."},{"idx":4,"correct":false,"proposition":"Eviction of cow's milk","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-1-qi-1","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":"What elements of the interrogation are you looking for to support this diagnosis? (one or more expected answers)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":" Spasmodic abdominal pain","justification":""},{"idx":1,"correct":true,"proposition":"Glairo-bloody emissions","justification":""},{"idx":2,"correct":false,"proposition":"Presence of watery stools","justification":""},{"idx":3,"correct":true,"proposition":"oozing","justification":""},{"idx":4,"correct":true,"proposition":"Description of spurs","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-1-qi-2","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" The patient reports spurs relieved by glairo-bloody emissions, which reinforces your hypothesis of proctitis. You learn that the patient has unprotected sex with episodic male partners. What arguments are you looking for in favor of an infectious etiology? (one or more expected answers)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Polyarthralgia","justification":""},{"idx":1,"correct":false,"proposition":"Mouth ulcers","justification":""},{"idx":2,"correct":true,"proposition":"Mucopurulent anal discharge","justification":""},{"idx":3,"correct":true,"proposition":"Inguinal lymphadenopathy","justification":""},{"idx":4,"correct":true,"proposition":"Fever","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-1-qi-3","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" The patient describes tenesmus but no muco-purulent discharge. There is no fever or deterioration in the general condition. The weight is 65 kg for a height of 1m70. The clinical examination does not find inguinal lymphadenopathy. The abdominal wall is not sensitive. What, at this stage, are the etiological hypotheses concerning this suspicion of proctitis? (one or more expected answers)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Salmonella infection","justification":""},{"idx":1,"correct":false,"proposition":"Shigella infection","justification":""},{"idx":2,"correct":true,"proposition":"Ulcerative colitis","justification":""},{"idx":3,"correct":true,"proposition":"Sexually transmitted infection","justification":""},{"idx":4,"correct":true,"proposition":"Amoebiasis","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-1-qi-4","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" What are the additional first-line examinations to be performed? (one or more expected answers)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Coproculture","justification":""},{"idx":1,"correct":true,"proposition":"Microbiological collection by rectal swab","justification":""},{"idx":2,"correct":true,"proposition":"Recto-sigmoidoscopy with biopsy for histopathological examination","justification":""},{"idx":3,"correct":true,"proposition":"Stool parasitology","justification":""},{"idx":4,"correct":true,"proposition":"HIV serology","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-1-qi-5","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" Rectal swab with PCR examination does not find Chlamydia trachomatis or Neisseria gonorrhoeae. HIV serology is negative. Parasitological examination of stool is negative. Endoscopic examination shows a rectal mucosa of granite appearance with erosions that bleed on contact with the endoscope. The lesions do not extend beyond the rectosigmoid hinge and the sigmoid mucosa is normal. Histological examination shows glandular distortions, cryptic abscesses and an inflammatory infiltrate of the chorion, consisting of lymphoplasmocytes and polynuclear cells. The diagnosis of ulcerative colitis is retained. You propose treatment with 5-amino-salicylates rectally. What information do you give the patient about their illness? (one or more expected answers)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Treatment can cure the disease permanently","justification":""},{"idx":1,"correct":true,"proposition":"A severe pancolic flare-up is possible","justification":""},{"idx":2,"correct":true,"proposition":"The risk of colorectal cancer is increased compared to the general population","justification":""},{"idx":3,"correct":false,"proposition":"The risk of primary biliary cirrhosis is increased compared to the general population","justification":""},{"idx":4,"correct":false,"proposition":"The risk of diverticular disease is increased compared to the general population","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-1-qi-6","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" The patient received maintenance therapy with 5 amino-salicylate suppository for 18 months. A few months later, after a period during which he was asymptomatic without treatment, he reported the presence of blood accompanying the stool for 15 days, without abdominal pain. What data do you seek, during the interrogation, in favor of a hemorrhoidal pathology at the origin of bleeding? (one or more expected answers)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Bleeding after defecation","justification":""},{"idx":1,"correct":true,"proposition":"Presence of pain per and post defecatory","justification":""},{"idx":2,"correct":false,"proposition":"Presence of mucus in the stool","justification":""},{"idx":3,"correct":true,"proposition":"Exemption from hard stools","justification":""},{"idx":4,"correct":false,"proposition":"Presence of spontaneous anal discharge containing traces of blood","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-1-qi-7","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" A colonoscopy is therefore performed and shows cicatricial proctitis and congestive hemorrhoids without procidence in the lumen of the anal canal. What support do you envisage? (one or more expected answers)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Rectal derivatives 5 amino-salicylates","justification":""},{"idx":1,"correct":true,"proposition":"Laxatives based on mucilages","justification":""},{"idx":2,"correct":true,"proposition":"Lubricating suppositories","justification":""},{"idx":3,"correct":false,"proposition":"Short course of nonsteroidal anti-inflammatory drugs","justification":""},{"idx":4,"correct":false,"proposition":"Surgical consultation to consider hemorrhoidectomy","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-1-qi-8","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" The symptomatology improved after a few days of treatment with lubricating suppositories and mucilage-based laxatives. During the follow-up, you carry out an assessment that objective: Hemoglobin: 14 g \/ dL \/ VGM: 85 fL \/ Leukocytes: 8.5 G \/ L \/ Polynuclear neutrophils: 5.3 G \/ L \/ Lymphocytes: 2.8 g \/ L \/ CRP: 6 mg \/ L \/ Ferritinemia: 80 μg \/ L (N: 50 -200 μg \/ L) \/ AST: 52 IU (N<35). What do you suspect?","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Hepatic colic","justification":""},{"idx":1,"correct":false,"proposition":"Cholangitis","justification":""},{"idx":2,"correct":false,"proposition":"Primary biliary cholangitis","justification":""},{"idx":3,"correct":false,"proposition":"Autoimmune hepatitis","justification":""},{"idx":4,"correct":true,"proposition":"Primary sclerosing cholangitis","justification":"This question was a hidden QRU"}],"type":"dp"}
+{"_id":"annales-2022-dp-1-qi-9","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" You suspect primary sclerosing cholangitis. What diagnostic tests do you perform as a first-line treatment? (one or more expected answers)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Hepatobiliary ultrasound","justification":""},{"idx":1,"correct":false,"proposition":"Biliary scintigraphy","justification":""},{"idx":2,"correct":true,"proposition":"Bili-MRI","justification":""},{"idx":3,"correct":false,"proposition":"High endoscopic echo","justification":""},{"idx":4,"correct":false,"proposition":"Endoscopic retrograde cholangiopancreatography","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-1-qi-10","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" Bili-MRI and ultrasound show a succession of dilatations and strictures of the bile duct, which suggests primitive sclerosing cholangitis. The patient is lost to follow-up and consults the emergency room 5 years later for jaundice associated with chills. Its vital parameters are: PA 130\/80 mmHg, FC92\/min, temperature 38.7°C.  There is no marbling. The biological assessment shows:Leukocytes 14 G\/LPolynuclear neutrophils 11.3 G\/LLymphocytes 2.6 G\/LCRP: 98 mg\/LASAT: 356 IU (N<35)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Bili-MRI","justification":""},{"idx":1,"correct":false,"proposition":"Upper endoscopic echoendoscopy","justification":""},{"idx":2,"correct":true,"proposition":"Hepatobiliary ultrasound","justification":""},{"idx":3,"correct":false,"proposition":"Liver CT scan","justification":""},{"idx":4,"correct":false,"proposition":"Endoscopic retrograde cholangiography","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-1-qi-11","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" Hepatobiliary ultrasound shows dilation of the intra- and extra-hepatic bile ducts upstream of stenosis of the main bile duct. What support do you offer? (one or more expected answers)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Corticosteroid therapy","justification":""},{"idx":1,"correct":true,"proposition":"Antibiotic therapy","justification":"This proposal was essential"},{"idx":2,"correct":false,"proposition":"Cholecystectomy","justification":""},{"idx":3,"correct":false,"proposition":"Ursodeoxycolic acid","justification":""},{"idx":4,"correct":true,"proposition":"Endoscopic retrograde cholangiography","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-1-qi-12","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" In this patient, which antibiotics are essential in the first line? (one or more expected answers)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Clindamycin","justification":""},{"idx":1,"correct":true,"proposition":"Cefotaxime","justification":""},{"idx":2,"correct":false,"proposition":"Amoxicillin","justification":""},{"idx":3,"correct":false,"proposition":"Vancomycin","justification":""},{"idx":4,"correct":false,"proposition":"Gentamicin","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-1-qi-13","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" You choose antibiotic therapy with cefotaxime and intravenous metronidazole. Which of the bacteria potentially involved in this infection is naturally resistant to the selected antibiotic therapy? (only one answer expected)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Enterococcus faecalis","justification":"This question was a QRU"},{"idx":1,"correct":false,"proposition":"Escherichia coli","justification":""},{"idx":2,"correct":false,"proposition":"Klebsiella pneumoniae","justification":""},{"idx":3,"correct":false,"proposition":"Streptococcus mitis","justification":""},{"idx":4,"correct":false,"proposition":"Bacteroides fragilis","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-1-qi-14","context":"A 25-year-old man is consulting for bloody diarrhea that has been progressing for a week after returning from a trip to Brazil. The patient has no medical or surgical history. He does not smoke or drink alcohol","enonce":" In addition to antibiotic therapy, with a view to stenting, the patient benefits from endoscopic retrograde cholangiopancreatography. The latter shows biliary stenosis with dilation of the bile ducts upstream. What are the following structures? (one or more expected answers)","item":"annales-2022-dp-1","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"1 is the gallbladder","justification":""},{"idx":1,"correct":false,"proposition":"2 is the common hepatic duct","justification":""},{"idx":2,"correct":false,"proposition":"3 is the fourth portion of the duodenum","justification":""},{"idx":3,"correct":true,"proposition":"4 corresponds to an intrahepatic bile duct","justification":""},{"idx":4,"correct":false,"proposition":"5 is the main pancreatic duct","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-2-qi-1","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" As part of its follow-up, you request a blood count that shows: red blood cells 3.1 T\/L, hemoglobin 105 g\/L, MCV 105 fl, MCHC 32 g\/dl, leukocytes 4.8 G\/L, neutrophils 2.8 G\/L, eosinophilic polynuclear 0.2 G\/L, lymphocytes 1.4 G\/L, monocytes 0.4 G\/L, platelets 152 G\/L.","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Reticulocytes","justification":""},{"idx":1,"correct":false,"proposition":"Creatinine emia","justification":""},{"idx":2,"correct":false,"proposition":"GammaGT","justification":""},{"idx":3,"correct":false,"proposition":"Dosage vitamins B9 and B12","justification":""},{"idx":4,"correct":false,"proposition":"Ferritinemia","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-2-qi-2","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" The assessment you had done shows reticulocytes at 2.5%. Which exams do you think are relevant? (one or more possible answers)","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"TSH","justification":""},{"idx":1,"correct":true,"proposition":"Creatinine clearance","justification":""},{"idx":2,"correct":false,"proposition":"Direct Coombs test","justification":""},{"idx":3,"correct":true,"proposition":"Dosage vitamins B9 and B12","justification":""},{"idx":4,"correct":false,"proposition":"Ferritinemia","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-2-qi-3","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" The assessment carried out shows a normal TSH, the creatinine clearance evaluated on serum creatinine is normal and dosages of vitamins B9 and B12 within normal limits. You write her a letter for a hematologist, whom she does not decide to consult until 6 months later. The NFS made on the day of the consultation shows: red blood cells 2.1 T\/L, hemoglobin 79 g\/L, MCV 110 fl, MCDC 34.3 g\/dl, reticulocytes 33 G\/L, leukocytes 3.9 G\/L, neutrophils 1.7 G\/L, eosinophils 0.2 G\/L, lymphocytes 1.4 G\/L, monocytes 0.6 G\/L, platelets 112 G\/L. On reading the blood smear, lecytologist notes signs of dysgranulopoiesis but no blast. What are the reasons for diagnosing myelodysplasia? (one or more possible answers)","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"history of chemotherapy","justification":""},{"idx":1,"correct":false,"proposition":"dyslipidemia treated with simvastatin","justification":""},{"idx":2,"correct":false,"proposition":"chronic alcoholism","justification":""},{"idx":3,"correct":true,"proposition":"dysgranulopoiesis on the blood smear","justification":""},{"idx":4,"correct":true,"proposition":"progressive worsening of cytopenias","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-2-qi-4","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" Which exams do you think are indicated at this stage? (one or more possible answers)","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Osteomedullary biopsy","justification":""},{"idx":1,"correct":true,"proposition":"Myelogram","justification":""},{"idx":2,"correct":true,"proposition":"Medullary karyotype","justification":""},{"idx":3,"correct":false,"proposition":"Hemoglobin electrophoresis","justification":""},{"idx":4,"correct":false,"proposition":"Search for the BCR-ABL1 transcript","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-2-qi-5","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" The myelogram shows a rich marrow with granular line 40%, of which 8% blasts, erythroblastic line 45%, lymphocytes 10%, monocytes 5%. Megakaryocytes are numerous. There are signs of dyserythropoiesis, dysgranulopoiesis, and dysmegakaryopoiesis. What diagnoses do you mention? (one or more correct answers)","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"acute myelogenous leukemia","justification":""},{"idx":1,"correct":false,"proposition":"chronic myelogenous leukemia","justification":""},{"idx":2,"correct":true,"proposition":"refractory anemia with excess blasts","justification":""},{"idx":3,"correct":false,"proposition":"megakaryoblastic leukemia","justification":""},{"idx":4,"correct":false,"proposition":"myeloma","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-2-qi-6","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" It is therefore a refractory anemia with excess blasts type 1.At first, you decide to transfuse the patient. She was never transfused and did not become pregnant. What needs to be done? (one or more possible answers)","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"the determination of the ABO Rhesus group must be carried out on two different samples","justification":""},{"idx":1,"correct":false,"proposition":"compatibility must be determined twice on the same sample","justification":""},{"idx":2,"correct":true,"proposition":"a search for irregular agglutinins is justified","justification":""},{"idx":3,"correct":false,"proposition":"the determination of the ABO group is sufficient for globular concentrates","justification":""},{"idx":4,"correct":false,"proposition":"the patient must receive irradiated red blood cells","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-2-qi-7","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" You propose to your patient to participate in a clinical trial testing a hypomethylating agent, an investigational drug that does not have the MA. About the patient's consent, what propositions are true? (one or more possible answers)","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"consent to participate in the trial may be given orally","justification":""},{"idx":1,"correct":true,"proposition":"consent must be signed by the patient and physician","justification":""},{"idx":2,"correct":true,"proposition":"consent must be signed without constraint and preceded by informed information","justification":""},{"idx":3,"correct":true,"proposition":"the information given to the patient before the possible signing of the consent can be given to him without the presence of a third party","justification":""},{"idx":4,"correct":false,"proposition":"Free and informed consent commits the patient to participate in the trial until its completion","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-2-qi-8","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" The hypomethylating investigational medicinal product has already been tested in phase I and its dose and pharmacokinetics have been determined. The trial you are proposing to your patient is a phase II trial. Which propositions are true? (one or more possible answers)","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"a phase II trial may include randomization","justification":""},{"idx":1,"correct":true,"proposition":"a phase II trial evaluates the effectiveness of a drug","justification":""},{"idx":2,"correct":true,"proposition":"a phase II trial must conventionally, if successful, be followed by a phase III trial to obtain a marketing authorization","justification":""},{"idx":3,"correct":true,"proposition":"phase II trials can test drug combinations","justification":""},{"idx":4,"correct":false,"proposition":"patients in phase II trials are generally advanced\/refractory","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-2-qi-9","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" The patient agrees to the clinical trial. It is warned of the risk of worsening cytopenias induced by the proposed treatment. What types of infections does severe neutropenia expose the patient to? (one or more possible answers)","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Bacterial pneumonia","justification":""},{"idx":1,"correct":false,"proposition":"Influenza","justification":""},{"idx":2,"correct":true,"proposition":"Gingivostomatitis","justification":""},{"idx":3,"correct":false,"proposition":"Pneumocystis jirovecii infection","justification":""},{"idx":4,"correct":true,"proposition":"Cellulitis","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-2-qi-10","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" During this treatment exposing to a risk of thrombocytopenia, what semiological elements would suggest a risk of serious bleeding? (one or more possible answers)","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Purpura of the lower limbs","justification":""},{"idx":1,"correct":true,"proposition":"Intraoral hemorrhagic bubbles","justification":""},{"idx":2,"correct":false,"proposition":"Gingivoragies brushing teeth","justification":""},{"idx":3,"correct":false,"proposition":"Conjunctival hemorrhage","justification":""},{"idx":4,"correct":true,"proposition":"Bleeding at the back of the eye","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-2-qi-11","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" She receives 6 monthly cures quite well tolerated but she remains cytopenic. She is rehospitalized one week before her 7th cure for alteration of the general condition with dyspnea of recent installation. The CBC shows hemoglobin at 65 g\/L, leukocytes at 98 G\/L with 80% myeloid blasts and platelets at 15 G\/L. The patient was admitted to the emergency department and transfused overnight. The next morning, she is very dyspneic. What are the two most likely diagnostic hypotheses to explain this dyspnea?","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"alveolar proteinosis","justification":""},{"idx":1,"correct":true,"proposition":"pulmonary edema of overload","justification":""},{"idx":2,"correct":false,"proposition":"pulmonary edema post-transfusion lesional","justification":""},{"idx":3,"correct":true,"proposition":"pulmonary leukostasis","justification":""},{"idx":4,"correct":false,"proposition":"plasma hyperviscosity","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-2-qi-12","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" The diagnosis finally retained is that of pulmonary edema of overload and dyspnea regresses rapidly under diuretic treatment. The patient is transferred to haematology for the management of her transformation into acute leukaemia. A hemostasis assessment shows: TP 30%, TCA patient\/control ratio 1.8, fibrinogen 0.7 g \/ l. D-dimer is at 9000 ng\/ml.How do you interpret this hemostasis assessment in this context? (one or more possible answers)","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Hepatocellular insufficiency","justification":""},{"idx":1,"correct":false,"proposition":"Acquired Willebrand disease","justification":""},{"idx":2,"correct":false,"proposition":"Antiphospholipid syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Disseminated intravascular coagulation","justification":""},{"idx":4,"correct":false,"proposition":"Cold agglutinin disease","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-2-qi-13","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" The diagnosis of DICD is mentioned, so the patient leaves the clinical trial. A cytoreductive treatment is started to try to reduce blast proliferation. The patient becomes oliguric and serum creatinine doubles in 24 hours. Which diagnosis do you think is most likely?","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Rapidly progressive glomerulonephritis","justification":""},{"idx":1,"correct":false,"proposition":"Thrombotic microangiopathy","justification":""},{"idx":2,"correct":true,"proposition":"Tumor lysis syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Rhabdomyolysis","justification":""},{"idx":4,"correct":false,"proposition":"Thrombosis of a renal artery","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-2-qi-14","context":"You see for the first time Madame V, a 70-year-old woman for a medical certificate for registration at aquagym. She has an active smoking at 30 PA. Her history includes stage 1 post-smoking COPD, dyslipidemia treated with simvastatin, and breast cancer treated 10 years ago for which she reportedly received chemotherapy. She has chronic alcohol sweaned.","enonce":" A tumor lysis syndrome is evoked, what biological argument(s) would be in favor of this diagnosis? (one or more possible answers)","item":"annales-2022-dp-2","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Hypokalemia","justification":""},{"idx":1,"correct":true,"proposition":"Hypocalcemia","justification":""},{"idx":2,"correct":true,"proposition":"Hyperuricemia","justification":""},{"idx":3,"correct":false,"proposition":"Hypophosphoremia","justification":""},{"idx":4,"correct":false,"proposition":"Hyperbilirubinemia","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-3-qi-1","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" Express in pack-years the smoking consumption of this man (only one answer expected)","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"54","justification":""},{"idx":1,"correct":false,"proposition":"44","justification":""},{"idx":2,"correct":false,"proposition":"27","justification":""},{"idx":3,"correct":false,"proposition":"22","justification":""},{"idx":4,"correct":false,"proposition":"14","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-3-qi-2","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" With the elements you have, what hypothesis(s) diagnosis (s) do you retain?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Upper airway infection","justification":""},{"idx":1,"correct":false,"proposition":"Acute respiratory failure","justification":""},{"idx":2,"correct":true,"proposition":"Exacerbation of chronic bronchitis","justification":""},{"idx":3,"correct":false,"proposition":"Alveolar pneumonia","justification":""},{"idx":4,"correct":false,"proposition":"Influenza","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-3-qi-3","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" What element(s) would be important to define the antibiotic therapeutic strategy?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Exact volume of sputum","justification":""},{"idx":1,"correct":true,"proposition":"Presence of exertional dyspnea","justification":""},{"idx":2,"correct":true,"proposition":"Presence of resting dyspnea","justification":""},{"idx":3,"correct":false,"proposition":"Excessive alcohol consumption","justification":""},{"idx":4,"correct":false,"proposition":"Winter context","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-3-qi-4","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" During a new interrogation, the patient reports dyspnea of effort for a few months. Which of the following antibiotics are indicated at this stage?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Levofloxacin","justification":""},{"idx":1,"correct":false,"proposition":"Amoxicillin","justification":""},{"idx":2,"correct":false,"proposition":"Metronidazole","justification":""},{"idx":3,"correct":false,"proposition":"Cefotaxime","justification":""},{"idx":4,"correct":false,"proposition":"Cotrimoxazole","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-3-qi-5","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" His condition improved after 7 days of amoxicillin. What do you foresee in the course of this episode?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Respiratory function tests","justification":""},{"idx":1,"correct":false,"proposition":"Allergological assessment","justification":""},{"idx":2,"correct":false,"proposition":"Lung scintigraphy","justification":""},{"idx":3,"correct":true,"proposition":"Pneumococcal vaccination","justification":""},{"idx":4,"correct":true,"proposition":"Annual influenza vaccination","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-3-qi-6","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" The patient is not seen again at the end of the episode. Six months after this first visit, he became unwell at home and was referred by his entourage to the emergency department. On clinical examination, the pulse is at 110 bpm, the temperature at 38.5 ° C, the blood pressure at 120\/70mmHg, the respiratory rate at 32 cycles \/ min with a saturation in ambient air of 91% initially. You mention pneumonia. Which clinical sign(s) would be in favor of this hypothesis?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"A hotbed of crackling","justification":""},{"idx":1,"correct":false,"proposition":"the presence of sibilants","justification":""},{"idx":2,"correct":false,"proposition":"decreased vocal vibration","justification":""},{"idx":3,"correct":false,"proposition":"A percussion tympanism","justification":""},{"idx":4,"correct":true,"proposition":"tubal murmur","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-3-qi-7","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" You have heard a focus of apical crackling upright. What is your assessment? (one or more correct answers)","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"venous Doppler of the lower limbs","justification":""},{"idx":1,"correct":false,"proposition":"a lung scan","justification":""},{"idx":2,"correct":true,"proposition":"chest x-ray","justification":""},{"idx":3,"correct":false,"proposition":"bronchial fibroscopy","justification":""},{"idx":4,"correct":false,"proposition":"bronchoalveolar lavage","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-3-qi-8","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" The chest X-ray is as follows: What is your interpretation?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Systematized impairment","justification":""},{"idx":1,"correct":false,"proposition":"Left upper lobar involvement","justification":""},{"idx":2,"correct":true,"proposition":"Alveolar syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Miliaria","justification":""},{"idx":4,"correct":false,"proposition":"Pneumothorax","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-3-qi-9","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" What biological assessment do you prescribe?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Blood platelet count","justification":""},{"idx":1,"correct":true,"proposition":"Blood ionogram - serum creatinine","justification":""},{"idx":2,"correct":true,"proposition":"Blood","justification":""},{"idx":3,"correct":false,"proposition":"Pneumococcal antigenemia","justification":""},{"idx":4,"correct":true,"proposition":"Cytobacteriological examination of sputum","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-3-qi-10","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" The laboratory assessment shows a biological inflammatory syndrome (CRP at 275 mg \/ L) with hyperleukocytosis. Biological kidney function is normal. Arterial lagazometrics is as follows: pH 7.48, PaO2 66 mmHg, PaCO 2 34 mmHg, HCO 3- 27 mmol \/ L.Regarding the cytobacteriological examination of sputum, which parameter(s) will encourage you to consider this examination as quality and reliable?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Monomicrobial character","justification":""},{"idx":1,"correct":false,"proposition":"Number of polynuclear units less than 25 per field","justification":""},{"idx":2,"correct":false,"proposition":"Number of bacterial colonies at 10 3 per m L","justification":""},{"idx":3,"correct":true,"proposition":"Number of epithelial cells less than 10 per field","justification":""},{"idx":4,"correct":false,"proposition":"Sampling in sputum medium","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-3-qi-11","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" Under 1 L\/min of nasal oxygen, saturation rises to 94% and respiratory rate drops to 22\/min. What is your attitude towards this patient? (one or more correct answers)","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Hospitalization in the medical department","justification":""},{"idx":1,"correct":false,"proposition":"Isolation \"air\"","justification":""},{"idx":2,"correct":false,"proposition":"Vancomycin treatment","justification":""},{"idx":3,"correct":false,"proposition":"Treatment with oseltamivir","justification":""},{"idx":4,"correct":false,"proposition":"Intravenous corticosteroid therapy","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-3-qi-12","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" A chest CT scan has been requested by your colleague on duty who also introduces treatment with amoxicillin-clavulanic acid. What is your interpretation of the image?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Alveolar condensation","justification":""},{"idx":1,"correct":false,"proposition":"Caves","justification":""},{"idx":2,"correct":false,"proposition":"Scissurite","justification":""},{"idx":3,"correct":false,"proposition":"Miliaria","justification":""},{"idx":4,"correct":true,"proposition":"Emphysema","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-3-qi-13","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" Two blood cultures are gram-positive diplococcus. Which antibiotic therapy(s) do you think are the most suitable at present?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Levofloxacin","justification":""},{"idx":1,"correct":false,"proposition":"Cefotaxime + spiramycin","justification":""},{"idx":2,"correct":false,"proposition":"Azithromycin","justification":""},{"idx":3,"correct":true,"proposition":"Amoxicillin","justification":""},{"idx":4,"correct":false,"proposition":"Amoxicillin + clavulanic acid","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-3-qi-14","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" Your patient's condition improves after 7 days of amoxicillin. As he goes home, he tells you that he worked for 30 years in insulation until his retirement, and handled a lot of asbestos. What pathology(s) can be related to this exposure to asbestos?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Pleural mesothelioma","justification":""},{"idx":1,"correct":false,"proposition":"Melanoma","justification":""},{"idx":2,"correct":true,"proposition":"Lung cancer","justification":""},{"idx":3,"correct":false,"proposition":"Ethmoid cancer","justification":""},{"idx":4,"correct":true,"proposition":"Asbestosis","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-3-qi-15","context":"A 68-year-old man comes to your office on January 15 for a chronic cough that is getting worse. This retired man (former construction worker) has been smoking since the age of 14, at a rate of about 20 cigarettes a day. He is also an excessive drinker, but says he has stopped for a month. It reports no other antecedent. He has been coughing for a few years, especially in the winter months. This cough is becoming almost constant and has increased in recent days. He has been spitting green in recent days. The clinical examination does not objectify any other abnormality.","enonce":" An objective control CT scan of bilateral non-calcified pleural plaques that had not been seen on the previous CT scan. Pleural plaques in a context of exposure to asbestos are the subject of an occupational disease table with a treatment period of 40 years. Can the patient claim recognition as an occupational disease?","item":"annales-2022-dp-3","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"No, because he is retired","justification":""},{"idx":1,"correct":false,"proposition":"No because he smoked","justification":""},{"idx":2,"correct":false,"proposition":"No because it is ethyl","justification":""},{"idx":3,"correct":true,"proposition":"Yes because of the principle of presumption of origin","justification":""},{"idx":4,"correct":true,"proposition":"Yes because it does not exceed the support time","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-4-qi-1","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" What is (are) the semeiological data(s) to be specified at the interrogation that would direct you towards the diagnosis of arteriopathy obliterans of the lower limbs?","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"the occurrence of this pain when walking","justification":"This proposal was essential"},{"idx":1,"correct":false,"proposition":"The characteristics of this pain type of electric shocks s","justification":""},{"idx":2,"correct":false,"proposition":"the disappearance of pain at elevation of the lower limbs","justification":""},{"idx":3,"correct":false,"proposition":"the later onset of pain when walking on hills than when walking on flat ground","justification":""},{"idx":4,"correct":true,"proposition":"the onset of pain for a constant walking distance on flat ground","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-4-qi-2","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" In this patient, the pain occurs when walking, only in the lower right limb, for a fixed distance on flat ground that he estimates at 350 meters with a cramp type sitting at the calf. You notice the presence of a right iliac murmur and a murmur in the lower 1\/3 of the left thigh. Femoral pulses are perceived on both the right and the left. The left popliteal pulse is very easily found it appears ample, the right popliteal pulse is not perceived. In distality you perceive only the left posterior tibial pulse and the left pedinous pulse. On these data you evoke the presence of an obliterating arterial disease of the lower limbs. Which arterial lesion(s) do you suspect based on these clinical data?","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Right iliac stenosis","justification":""},{"idx":1,"correct":true,"proposition":"right femoral obliteration","justification":""},{"idx":2,"correct":false,"proposition":"obliteration of right leg arteries","justification":""},{"idx":3,"correct":true,"proposition":"Left femoral stenosis","justification":""},{"idx":4,"correct":true,"proposition":"Left popliteal aneurysm","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-4-qi-3","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" The clinical examination data led you to suspect the existence of right iliac stenosis, right femoral obliteration, left femoral stenosis and left popliteal aneurysm. What are the first two tests you need to order to confirm your diagnosis of peripheral arterial disease and to locate the arterial lesions you suspected?","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"arteriogram of the lower limbs","justification":""},{"idx":1,"correct":true,"proposition":"a measurement of ankle systolic pressure indexes","justification":""},{"idx":2,"correct":true,"proposition":"arterial Doppler ultrasound of the lower limbs","justification":""},{"idx":3,"correct":false,"proposition":"angiography of the lower limbs","justification":""},{"idx":4,"correct":false,"proposition":"MRI of the lower limbs","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-4-qi-4","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" The measurement of ankle pressure indexes confirmed the diagnosis of peripheral arterial disease obliterating the lower limbs (humeral systolic pressure at 166mmHg in the right arm and 162 mmHg in the left arm with systolic pressure in the right ankle at 114 mmHg: IPS at 0.69 on the right and systolic pressure in the left ankle at 132 mmHg:  IPS at 0.80 on the left). The Doppler ultrasound of the aorta and lower limbs shows: a normal aorta (antero-posterior diameter at 22 mm), a stenosis at 50% of the right external iliac artery, an obliteration of the right femoral artery with reinjection of the popliteal artery. The left femoral artery has a non-significant stenosis and the other arterial axes on the left are the site of diffuse atheromatous overload but without significant obstructive lesion. The left popliteal artery is not aneurysmal. The examination does not retain significant lesion of the leg arteries on the right or left. There is obliterating arterial disease of the lower extremities. What is the element that allows you to say that it is at the stage of exercise ischemia?","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"the value of the patient's estimated walking distance below the threshold of 500 meters","justification":""},{"idx":1,"correct":true,"proposition":"symptomatic character to intermittent claudication type","justification":""},{"idx":2,"correct":false,"proposition":"ankle systolic pressure greater than 50 mmHg","justification":""},{"idx":3,"correct":false,"proposition":"the value of the ankle pressure indexes less than 0.90","justification":""},{"idx":4,"correct":false,"proposition":"the existence of humeral anisotension","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-4-qi-5","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" In this symptomatic patient at the claudication stage, additional examinations objectified ankle systolic pressures greater than 50 mmHg and SNPIs <0.90 confirming the diagnosis of peripheral arterial disease of the lower limbs at the stage of exercise ischemia. There is no aneurysmal lesion, there is 50% right iliac stenosis and right femoral obliteration. The assessment of vascular risk factors in this former smoker did not find diabetes. What therapeutic strategies are possible at this stage? (one or more expected answers)","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"gait rehabilitation","justification":""},{"idx":1,"correct":false,"proposition":"Revascularization","justification":""},{"idx":2,"correct":true,"proposition":"Anti-aggregant treatment with aspirin","justification":""},{"idx":3,"correct":true,"proposition":"statin therapy","justification":""},{"idx":4,"correct":false,"proposition":"anticoagulant therapy","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-4-qi-6","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" The patient begins gait rehabilitation. He now receives atorvastatin, acetyl-salicylic acid, indapamide, fluoxetine and lercanidipine. He returned for consultation 3 months later. He performed a self-measurement cycle, the averaged values are 139\/64 mmHgThe blood pressure is measured at 160\/80 mmHg at the beginning of the consultation and then at 146\/60 mmHg symmetrically 15 minutes later. At this stage, what type(s) of high blood pressure can be suspected in this patient?","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Systolic hypertension","justification":""},{"idx":1,"correct":false,"proposition":"Resistant HTA","justification":""},{"idx":2,"correct":false,"proposition":"Masked HTA","justification":""},{"idx":3,"correct":false,"proposition":"Systolo-diastolic hypertension","justification":""},{"idx":4,"correct":false,"proposition":"HTA << white coat>>","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-4-qi-7","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" A biological assessment carried out before this visit shows: Na 130 mmol \/ L, K 3.4 mmol \/ L, serum creatinine 75 μmol \/ L. LDL cholesterol is 0.90 g \/ L.Among the treatments taken by the patient, which drug (s) can (can) explain the abnormalities of the ionogram?","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"indapamide","justification":""},{"idx":1,"correct":false,"proposition":"atorvastatin","justification":""},{"idx":2,"correct":true,"proposition":"fluoxetine","justification":""},{"idx":3,"correct":false,"proposition":"acetyl salicylic acid","justification":""},{"idx":4,"correct":false,"proposition":"lercanidipine","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-4-qi-8","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" Regarding the management of high blood pressure, what change(s) do you make to this patient's prescription?","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Indapamide judgment","justification":""},{"idx":1,"correct":false,"proposition":"Lercanidipine stop","justification":""},{"idx":2,"correct":false,"proposition":"Prescription of furosemide","justification":""},{"idx":3,"correct":true,"proposition":"prescription of an ACE inhibitor","justification":""},{"idx":4,"correct":false,"proposition":"Prescription of a beta-blocker","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-4-qi-9","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" You replace indapamide with an ACE inhibitor. In addition, what other measure(s) do you propose to this patient?","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"the prescription of potassium supplementation","justification":""},{"idx":1,"correct":false,"proposition":"the decrease in beverages to 0.75 liters per day","justification":""},{"idx":2,"correct":false,"proposition":"increased sodium intake","justification":""},{"idx":3,"correct":true,"proposition":"Annual flu vaccination","justification":""},{"idx":4,"correct":true,"proposition":"decreased alcohol consumption","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-4-qi-10","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" What is the most suitable test to evaluate the effectiveness of antihypertensive treatment in this patient? (only one exact answer)","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"resting electrocardiogram","justification":""},{"idx":1,"correct":true,"proposition":"Voltage self-measurement","justification":""},{"idx":2,"correct":false,"proposition":"echocardiography","justification":""},{"idx":3,"correct":false,"proposition":"24-hour voltage recording (MAPA)","justification":""},{"idx":4,"correct":false,"proposition":"24-hour electrocardiographic recording (Holter)","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-4-qi-11","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" What is (are) the expected benefit(s) of your care?","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"decreased risk of stroke","justification":""},{"idx":1,"correct":true,"proposition":"decreased risk of heart failure","justification":""},{"idx":2,"correct":false,"proposition":"decreased risk of aortic valve disease","justification":""},{"idx":3,"correct":true,"proposition":"decrease in cardiovascular mortality","justification":""},{"idx":4,"correct":false,"proposition":"Decreased thromboembolic venous risk","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-4-qi-12","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" The patient is currently being treated with ACE inhibitor and calcium channel blocker for antihypertensive purposes. Self-measurement shows an average blood pressure of 158\/72 mmHg.What are you looking for at the origin of this therapeutic ineffectiveness in this patient? (one or more correct answers)","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"fibromuscular dysplasia of the renal arteries","justification":""},{"idx":1,"correct":true,"proposition":"alcohol abuse","justification":""},{"idx":2,"correct":true,"proposition":"non-adherence","justification":""},{"idx":3,"correct":true,"proposition":"sleep apnea syndrome","justification":""},{"idx":4,"correct":true,"proposition":"improper use of the blood pressure self-measuring device","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-4-qi-13","context":"A 72-year-old man consults you for the occurrence of pain in the lower right limb occurring for 3 weeks. He is 1.74 m tall and weighs 82 kg (BMI 27.1 kg\/m2). Cardiac auscultation and pulmonary auscultation are normal. Blood pressure is 166\/80 mmHg in the right arm and 162\/78 mmHg in the left arm. Palpation of the abdomen is difficult but the belly is flexible and not painful. He has been treated for high blood pressure for 5 years with indapamide and lercanidipine. He is a former smoker weaned for 2 years after 50 packs.years. He has been followed for a depressive syndrome for a year, treated with fluoxetine. He has been asthenic for a few days, without sleep disorder. He says he pays attention to the quality of his diet by limiting animal fats and sodium intake. He drinks about 2 liters of tap water and 2 glasses of red wine a day. A biological assessment carried out before this visit shows: Na 132 mmol \/ L, K 3.6 mmol \/ L, serum creatinine 70 µmol \/ L, total cholesterol 1.76 g \/ L, triglycerides 1.3 g \/ L, HDL-C 0.55 g \/ L, LDL-C 0.95 g \/ L.","enonce":" Poor blood pressure control was linked to medication non-adherence. The patient received therapeutic education. During the first check-up visit to his general practitioner, the blood pressure self-measurement values are in the objectives. Biological abnormalities are normalized. You renew his treatment. What follow-up do you propose to this patient? (one or more correct answers)","item":"annales-2022-dp-4","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"annual echocardiography","justification":""},{"idx":1,"correct":false,"proposition":"a stress test every two years","justification":""},{"idx":2,"correct":false,"proposition":"a monthly consultation with the general practitioner","justification":""},{"idx":3,"correct":true,"proposition":"an annual blood ionogram","justification":""},{"idx":4,"correct":true,"proposition":"Blood pressure monitoring by self-measurement","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-5-qi-1","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" Here is the dermatological aspect of the patient. What semiological characteristics do you find on the 2 photos? (one or more correct answers)","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"èrythema","justification":""},{"idx":1,"correct":true,"proposition":"Papules","justification":""},{"idx":2,"correct":true,"proposition":"Dander","justification":""},{"idx":3,"correct":false,"proposition":"annular lesions","justification":""},{"idx":4,"correct":false,"proposition":"Vesicles","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-5-qi-2","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" From your semiological analysis and the history of this patient, which dermatological diagnosis seems to you to be the most likely? (only one response expected)","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Atopic dermatitis","justification":""},{"idx":1,"correct":false,"proposition":"maculopapular exanthema with bisoprolol","justification":""},{"idx":2,"correct":false,"proposition":"pityriasis rosé of Gibert","justification":""},{"idx":3,"correct":true,"proposition":"psoriasis","justification":""},{"idx":4,"correct":false,"proposition":"Mycosis fungoides","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-5-qi-3","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" You remember the diagnosis of psoriasis. How do you assess the intensity, severity and impact of it? (one or more correct answers)","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"PASI score","justification":""},{"idx":1,"correct":false,"proposition":"Genetic analysis for determination of susceptibility genes","justification":""},{"idx":2,"correct":true,"proposition":"dermatology life quality index (DLQI) score","justification":""},{"idx":3,"correct":false,"proposition":"rheumatoid factor test","justification":""},{"idx":4,"correct":true,"proposition":"radiography of the pelvis","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-5-qi-4","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" You suspect the association with psoriatic arthritis. What semiological and anamnestic elements would be in favor of this association? (one or more correct answers)","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"the existence of heel pain","justification":""},{"idx":1,"correct":true,"proposition":"nail damage","justification":""},{"idx":2,"correct":true,"proposition":"scalp involvement","justification":""},{"idx":3,"correct":false,"proposition":"high PASI score","justification":""},{"idx":4,"correct":false,"proposition":"Late onset in adulthood","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-5-qi-5","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" The PASI score is 22 (severe form) and the DLQI shows a profound alteration in the quality of life of this patient. At this stage, psoriatic arthritis is not confirmed. Blood ionogram, kidney function and liver function are normal. What are the treatment options available as a first-line treatment? (one or more correct answers)","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Local treatment with betamethasone and calcipotriol","justification":""},{"idx":1,"correct":true,"proposition":"UVB phototherapy","justification":""},{"idx":2,"correct":false,"proposition":"local treatment with vitamin D analogue","justification":""},{"idx":3,"correct":true,"proposition":"methotrexate","justification":""},{"idx":4,"correct":false,"proposition":"biotherapy","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-5-qi-6","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" The patient living in a rural area far from a phototherapy center, he asks you for an effective treatment because he is very affected by the extension of his dermatosis which confines him to his home. Which treatment do you prefer for this patient? (only one answer expected)","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Spa","justification":""},{"idx":1,"correct":false,"proposition":"hydroxychloroquine","justification":""},{"idx":2,"correct":true,"proposition":"methotrexate","justification":""},{"idx":3,"correct":false,"proposition":"cyclosporine","justification":""},{"idx":4,"correct":false,"proposition":"salazopyrin","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-5-qi-7","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" The patient's hypertension makes you prefer methotrexate to ciclosporin. You start treatment with 17.5 mg methotrexate weekly. You see the patient again after 3 months, the PASI score (Psoriasis Area and Severity Index) is 15, the heel pain is less intense but the patient still has hip pain for which he regularly takes NSAIDs. You are considering the use of biotherapy. What elements are part of your pre-therapeutic assessment? (one or more correct answers)","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"IGRA (quantiferon®) test","justification":""},{"idx":1,"correct":true,"proposition":"HIV testing serology","justification":""},{"idx":2,"correct":true,"proposition":"hepatitis B and C screening serologies","justification":""},{"idx":3,"correct":true,"proposition":"Verification of vaccinations","justification":""},{"idx":4,"correct":false,"proposition":"Thoraco-abdomino-pelvic CT scan","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-5-qi-8","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" What three biotherapies are you considering for this patient?","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Anti-CD20","justification":""},{"idx":1,"correct":true,"proposition":"Anti-IL-12\/IL-23","justification":""},{"idx":2,"correct":true,"proposition":"Anti-IL-17","justification":""},{"idx":3,"correct":true,"proposition":"Anti-TNFalpha","justification":""},{"idx":4,"correct":false,"proposition":"Anti-PD-1","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-5-qi-9","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" You have chosen to introduce an anti-IL17 biotherapy.What other elements should be considered in the management of psoriasis? (one or more correct answers)","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Dieting","justification":""},{"idx":1,"correct":true,"proposition":"Limiting alcohol intake","justification":""},{"idx":2,"correct":false,"proposition":"Valsartan stop","justification":""},{"idx":3,"correct":true,"proposition":"Bisoprolol replacement","justification":""},{"idx":4,"correct":true,"proposition":"seasonal influenza vaccination","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-5-qi-10","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" You see the patient again 1 year later, he followed your advice, lost 5 kgs. Psoriasis was greatly improved by an anti IL-17. As the prescription has not been renewed, the patient has not received any treatment for 4 months. He complains of persistent pain in his right foot (see photo). What diagnosis do you envisage for the involvement of the right big toe? (only one answer expected)","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"whitlow","justification":""},{"idx":1,"correct":false,"proposition":"Primary herpes infection","justification":""},{"idx":2,"correct":false,"proposition":"chronic candidosis dactylitis","justification":""},{"idx":3,"correct":true,"proposition":"onycho-pachydermo-periostitis","justification":""},{"idx":4,"correct":false,"proposition":"drop","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-5-qi-11","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" What test do you request in first line to confirm the diagnosis of onycho-pachydermo-periostitis? (only one answer expected)","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"X-ray of the feet","justification":""},{"idx":1,"correct":false,"proposition":"MRI right big toe","justification":""},{"idx":2,"correct":false,"proposition":"ultrasound of soft parts","justification":""},{"idx":3,"correct":false,"proposition":"rheumatoid factor test","justification":""},{"idx":4,"correct":false,"proposition":"CRP test","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-5-qi-12","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" The X-ray of the feet confirms your hypothesis. In association with the resumption of anti-IL-17, you have infiltrated cortisonic derivatives and prescribed non-steroidal anti-inflammatory drugs on demand. During a biological assessment to monitor the treatment, you find a high ferritinemia greater than 600 ng\/ml (N: 30-300). What is the most likely cause? (only one answer expected)","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Hereditary hemochromatosis","justification":""},{"idx":1,"correct":false,"proposition":"Psoriasis","justification":""},{"idx":2,"correct":true,"proposition":"Metabolic syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Beginning hepatic cirrhosis","justification":""},{"idx":4,"correct":false,"proposition":"Excessive meat consumption","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-5-qi-13","context":"A 56-year-old man consults for dermatosis, extensive for several months, treated episodically with topical corticosteroids without real effectiveness. This sedentary patient in pre-retirement measures 174 cm for 99 kilos. He has a history of hypertension treated with valsartan and hydrochlorothiazide with the introduction of bisoprolol 6 months ago, type 2 diabetes treated with glibenclamide and hypercholesterolemia treated with atorvastatin. He was recently fitted with a continuous positive airway pressure device for sleep apnea. He has been smoking since the age of 17 (25 cigarettes a day) and is in the process of quitting. He acknowledges a daily addiction to alcohol. At the interrogation, this patient evokes a general fatigue and a diffuse pain syndrome. He suffers from pain in both heels during prolonged walking, hip pain and low back pain that he attributes to his overweight.","enonce":" You consider that the metabolic syndrome that this patient presents is the most likely cause of this hyperferritinemia. What therapeutic measure(s) do you propose in the context of this patient?","item":"annales-2022-dp-5","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"low-calorie diet","justification":""},{"idx":1,"correct":true,"proposition":"Replacement of glibenclamide with metformin","justification":""},{"idx":2,"correct":false,"proposition":"Limiting daily dietary intake of iron to less than 5 mg\/d","justification":""},{"idx":3,"correct":false,"proposition":"bloodletting","justification":""},{"idx":4,"correct":false,"proposition":"treatment with deferoxamine","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-6-qi-1","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" For this patient, what information available makes you suspect sleep apnea syndrome? (one or more correct answers)","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Daytime sweating","justification":""},{"idx":1,"correct":true,"proposition":"Systemic arterial hypertension","justification":""},{"idx":2,"correct":true,"proposition":"Obesity","justification":""},{"idx":3,"correct":true,"proposition":"Nocturnal snoring","justification":""},{"idx":4,"correct":true,"proposition":"Decreased libido","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-6-qi-2","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" You perform a nocturnal polygraph that targets a hypopnea apnea index of 55\/h and confirms severe obstructive sleep apnea syndrome. What treatments do you offer as a first-line treatment? (one or more correct answers)","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Bariatric surgery","justification":""},{"idx":1,"correct":false,"proposition":"Inhaled bronchodilators","justification":""},{"idx":2,"correct":true,"proposition":"Continuous positive airway pressure","justification":""},{"idx":3,"correct":true,"proposition":"Hygiene-dietary rules","justification":""},{"idx":4,"correct":false,"proposition":"Pulmonary rehabilitation","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-6-qi-3","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" As part of his profession as a bus driver, what measures do you recommend? (one or more correct answers)","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"A work stoppage at the beginning of the care","justification":""},{"idx":1,"correct":false,"proposition":"Outplacement","justification":""},{"idx":2,"correct":true,"proposition":"A wakefulness maintenance test after 1 month of well-conducted treatment","justification":""},{"idx":3,"correct":false,"proposition":"Information about his sleep apnea from his employer","justification":""},{"idx":4,"correct":false,"proposition":"Stopping amlodipine","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-6-qi-4","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" Despite the appropriate and effective management of sleep apnea syndrome for several months, your patient's wife sees no improvement in their sex life. What clinical elements would point to the existence of hypogonadism in this patient? (one or more correct answers)","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Baldness","justification":""},{"idx":1,"correct":true,"proposition":"Gynecomastia","justification":""},{"idx":2,"correct":false,"proposition":"An enlarged prostate","justification":""},{"idx":3,"correct":true,"proposition":"The absence of morning erection","justification":""},{"idx":4,"correct":false,"proposition":"Night cramps","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-6-qi-5","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" Testicular palpation reveals small testicles, he has gynecomastia and states that he does not have a morning erection. You strongly suspect acquired male hypogonadism. Which biological examination, for diagnostic purposes, is the most relevant at this stage? (only one answer expected)","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Total testosteronemia","justification":""},{"idx":1,"correct":false,"proposition":"PSA assay","justification":""},{"idx":2,"correct":false,"proposition":"Prolactin dosage","justification":""},{"idx":3,"correct":false,"proposition":"cortisol at 8am","justification":""},{"idx":4,"correct":false,"proposition":"spermogram and spermocytogram","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-6-qi-6","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" You prescribe a total testosterone assay performed one morning on an empty stomach whose result is: 1.2 ng \/ mL (N: 4-10). What are the two tests that you must imperatively prescribe to advance in your diagnostic process?","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"LH","justification":""},{"idx":1,"correct":false,"proposition":"Free testosterone","justification":""},{"idx":2,"correct":true,"proposition":"Prolactin","justification":""},{"idx":3,"correct":false,"proposition":"Sulfate de DHEA","justification":""},{"idx":4,"correct":false,"proposition":"hCG","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-6-qi-7","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" Here are the results of this assessment: LH 3.3 IU\/L ( N: 2.1 - 6.3); prolactin 54 μg\/L (N < 20). At this stage, what is the most relevant imaging test? (only one answer expected)","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"MRI of the hypothalamic-pituitary region","justification":""},{"idx":1,"correct":false,"proposition":"Testicular ultrasound","justification":""},{"idx":2,"correct":false,"proposition":"Prostatic ultrasound","justification":""},{"idx":3,"correct":false,"proposition":"Abdominopelvic CT scan","justification":""},{"idx":4,"correct":false,"proposition":"Thyroid ultrasound","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-6-qi-8","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" You request an MRI of the hypothalamic-pituitary region, a section of which is shown below. Which of the following are true? (one or more correct answers)","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"This is a coronal cup","justification":""},{"idx":1,"correct":false,"proposition":"This is a sequence in T2","justification":""},{"idx":2,"correct":true,"proposition":"There is pituitary adenoma","justification":""},{"idx":3,"correct":false,"proposition":"The arrow indicates the hypothalamus","justification":""},{"idx":4,"correct":false,"proposition":"There is an attack of the optic chiasma","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-6-qi-9","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" Among the elements at your disposal, which can guide you towards the diagnosis of acromegaly in this patient? (one or more correct answers)","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"High blood pressure","justification":""},{"idx":1,"correct":true,"proposition":"Sleep apnea syndrome","justification":""},{"idx":2,"correct":false,"proposition":"Obesity","justification":""},{"idx":3,"correct":false,"proposition":"Low libido","justification":""},{"idx":4,"correct":true,"proposition":"Excessive sweating","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-6-qi-10","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" You recover the IGF1 test that you requested as part of the pituitary assessment. It returns moderately increased for the age of the patient. In order to establish your diagnosis of acromegaly, you perform oral induced hyperglycemia (OPGH) with 75 grams of glucose whose results are as follows:","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Changes in GH testing during OPGH are sufficient to confirm the diagnosis of acromegaly","justification":""},{"idx":1,"correct":false,"proposition":"Concomitant testing of IGF1 and GH is necessary to diagnose acromegaly","justification":""},{"idx":2,"correct":false,"proposition":"Diagnosis of acromegaly is based on concomitant blood glucose and GH testing during OPGH","justification":""},{"idx":3,"correct":false,"proposition":"Concomitant insulin and GH testing is necessary to diagnose acromegaly","justification":""},{"idx":4,"correct":false,"proposition":"The concomitant discovery of diabetes mellitus prevents the interpretation of the GH assay","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-6-qi-11","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" You have been diagnosed with acromegaly and diabetes mellitus. He was cared for and considered cured of his acromegaly. His diabetes persists. Among the following biological results, what would be the two elements expected in the context of type 2 diabetes of recent discovery?","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Triglycerides at 2.40 g\/L (N: 0.6 - 1.6)","justification":""},{"idx":1,"correct":false,"proposition":"HDL-C at 0.68 g\/L (N > 0.35)","justification":""},{"idx":2,"correct":false,"proposition":"LDL-C at 1.85 g\/L (N: 0.6 - 1.6)","justification":""},{"idx":3,"correct":false,"proposition":"AST at 85 IU\/L (N < 35) and ALT at 35 IU\/L (N < 40)","justification":""},{"idx":4,"correct":true,"proposition":"HbA1c at 8.5% (N < 7%)","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-6-qi-12","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" Metformin was introduced about one year after diagnosis. HbA1c is now at 7.3%, with late morning blood glucose levels at 2.30 g\/L. His current BMI is 28.5 kg\/m 2.Which of the following treatment options do you think is the most relevant?","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Adding a rapid-acting insulin injection before breakfast","justification":""},{"idx":1,"correct":true,"proposition":"Addition of sitagliptin","justification":"This question was a single answer, as indicated in the statement"},{"idx":2,"correct":false,"proposition":"Addition of acarbose","justification":""},{"idx":3,"correct":false,"proposition":"Addition of an analogue of GLP1","justification":""},{"idx":4,"correct":false,"proposition":"Adding a slow insulin injection at bedtime","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-6-qi-13","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" His treatment was intensified by the addition of sitagliptin. Which of the following elements from his medical history constitute an issue in order to validate or not his fitness to drive buses?","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Metformin treatment","justification":""},{"idx":1,"correct":false,"proposition":"treatment of high blood pressure","justification":""},{"idx":2,"correct":false,"proposition":"History of acromegaly","justification":""},{"idx":3,"correct":false,"proposition":"Treatment with sitagliptin","justification":""},{"idx":4,"correct":true,"proposition":"sleep apnea syndrome","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-6-qi-14","context":"A 48-year-old patient, a bus driver, consults you at the request of his wife because of nocturnal snoring that bothers her. During this consultation, his wife also complains of an unsatisfactory sex life for the past 3 years. Instead, he complains of excessive sweating, which sometimes hinders him in his daily life. He is 1.75 m tall and weighs 95 kg, giving a BMI of 31 kg\/m2. He has been taking amlodipine for high blood pressure as his only treatment for five years.","enonce":" He complains of edema of the lower limbs which he attributes to amlodipine. He wants to stop this treatment. What therapeutic classes can be indicated for him in first line? (one or more correct answers)","item":"annales-2022-dp-6","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"central antihypertensive drug","justification":""},{"idx":1,"correct":true,"proposition":"ACE inhibitor","justification":""},{"idx":2,"correct":true,"proposition":"Sartan","justification":""},{"idx":3,"correct":false,"proposition":"beta-blocker","justification":""},{"idx":4,"correct":false,"proposition":"thiazide diuretic","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-7-qi-1","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" What measures do you take in the emergency room, when the patient is admitted? (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"intravenous analgesic","justification":""},{"idx":1,"correct":false,"proposition":"Treatment with vasopressive amines","justification":""},{"idx":2,"correct":false,"proposition":"placement of a urinary catheter","justification":""},{"idx":3,"correct":true,"proposition":"nasogastric tube placement","justification":""},{"idx":4,"correct":true,"proposition":"vascular filling","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-7-qi-2","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" Regarding the abdominal contracture of this patient, what are the exact proposals? (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"there is peritoneal irritation","justification":""},{"idx":1,"correct":true,"proposition":"It's a surgical emergency","justification":""},{"idx":2,"correct":false,"proposition":"  It may be related to significant desydratation","justification":""},{"idx":3,"correct":true,"proposition":"it is invincible on palpation","justification":""},{"idx":4,"correct":false,"proposition":"it is voluntary, in reaction to abdominal palpation","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-7-qi-3","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" What diagnoses do you mention at this stage? (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"a perforated ulcer","justification":""},{"idx":1,"correct":true,"proposition":"diverticular perforated peritonitis","justification":""},{"idx":2,"correct":false,"proposition":"hepatic colic","justification":""},{"idx":3,"correct":false,"proposition":"acute pyelonephritis","justification":""},{"idx":4,"correct":true,"proposition":"appendicular peritonitis","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-7-qi-4","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" What biological tests do you prescribe urgently? (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"blood type and search for irregular agglutinins","justification":""},{"idx":1,"correct":false,"proposition":"serology Helicobacter pylori","justification":""},{"idx":2,"correct":true,"proposition":"Blood","justification":""},{"idx":3,"correct":true,"proposition":"serum creatinine","justification":""},{"idx":4,"correct":true,"proposition":"TP and TCA","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-7-qi-5","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" What additional examination do you request to establish your etiological diagnosis? (only one answer expected)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Abdominopelvic ultrasound","justification":""},{"idx":1,"correct":false,"proposition":"X-ray of the abdomen without preparation","justification":""},{"idx":2,"correct":true,"proposition":"Abdomino-pelvic CT scan","justification":""},{"idx":3,"correct":false,"proposition":"Gastro-duodenal fibroscopy","justification":""},{"idx":4,"correct":false,"proposition":"chest X-ray","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-7-qi-6","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" Here are some scannographic sections:What are the exact proposals? (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"it is an abdominopelvic scan in axial section (transverse)","justification":""},{"idx":1,"correct":false,"proposition":"the number 1 corresponds to the uterus","justification":""},{"idx":2,"correct":true,"proposition":"the number 2 corresponds to an effusion in Douglas' cul de sac","justification":""},{"idx":3,"correct":true,"proposition":"The number 3 corresponds to an appendicular stercolith","justification":""},{"idx":4,"correct":false,"proposition":"The right kidney is visible in one of these pictures","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-7-qi-7","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" About this scannographic section:What are the exact proposals? (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"the aorta is visible","justification":""},{"idx":1,"correct":false,"proposition":"there is a pneumoperitoneum","justification":""},{"idx":2,"correct":false,"proposition":"the number 4 corresponds to the left kidney","justification":""},{"idx":3,"correct":true,"proposition":"  The number 5 corresponds to a fluid effusion","justification":""},{"idx":4,"correct":false,"proposition":"There is a cluster of slender loops","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-7-qi-8","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" About digestive vascular anatomy, what are the exact answers? (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"the celiac trunk gives rise to the left gastric artery, the common hepatic artery and the splenic artery","justification":""},{"idx":1,"correct":true,"proposition":"the Riolan arch is an anastomosis between the upper and lower mesenteric territory","justification":""},{"idx":2,"correct":true,"proposition":"The appendix is vascularized by an arterial branch from the superior mesenteric artery","justification":""},{"idx":3,"correct":false,"proposition":"the right colon is vascularized by the inferior mesenteric artery","justification":""},{"idx":4,"correct":false,"proposition":"The inferior mesenteric vein drains into the inferior vena cava","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-7-qi-9","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" You are diagnosed with acute generalized peritonitis of appendicular origin. What are the main principles of management of this pathology? (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"The surgery may be postponed for a few hours under the guise of antibiotic therapy","justification":""},{"idx":1,"correct":true,"proposition":"At this stage, intravenous broad-spectrum antibiotic therapy should be prescribed.","justification":""},{"idx":2,"correct":true,"proposition":"A peritoneal toilet with saline will be systematically performed","justification":""},{"idx":3,"correct":false,"proposition":"An appendectomy and resection of the cecum more or less extensive to the ascending colon must be performed","justification":""},{"idx":4,"correct":true,"proposition":"The appendix is systematically sent to the Anatomical Pathology Laboratory","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-7-qi-10","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" The patient receives an emergency appendectomy with peritoneal toilet. She has a postoperative antibiotic therapy for 5 days paramoxicillin-clavulanic acid, adapted to the identification of a multisensitive Escherichia coli isolated in samples taken intraoperatively. The postoperative follow-up is simple. Discharge is allowed on the 6th postoperative day. The patient is urgently readmitted 48 hours later for hyperthermia at 38.5 ° C associated with abdominal pain. The digital rectal examination objective a painful pelvic mass. What is the most likely diagnosis? (only one answer expected)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"pyelonephritis","justification":""},{"idx":1,"correct":true,"proposition":"a Douglassian abscess","justification":""},{"idx":2,"correct":false,"proposition":"phlebitis of the ovarian vein","justification":""},{"idx":3,"correct":false,"proposition":"a wall abscess","justification":""},{"idx":4,"correct":false,"proposition":"ulcer perforation","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-7-qi-11","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" The patient quickly benefits from an abdominopelvic CT scan confirming the diagnosis of abscesses at the pelvic level, measured at 6 cm. (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"  there is no need to hospitalize the patient","justification":""},{"idx":1,"correct":true,"proposition":"drainage is required to drain the abscess","justification":""},{"idx":2,"correct":true,"proposition":"a bacteriological sample of the contents of the abscess must be taken","justification":""},{"idx":3,"correct":true,"proposition":"  Percutaneous radio-guided drainage is possible","justification":""},{"idx":4,"correct":false,"proposition":"Antibiotic therapy with amoxicillin-clavulanic acid should be resumed","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-7-qi-12","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" The patient is hospitalized. The abscess is drained under CT control. Antibiotic therapy is adapted to bacteriological samples taken during drainage. There is no need to reoperate the patient. Six months later, she consults for the appearance of an umbilical swelling, appeared at the level of an incision scar. What signs point to uncomplicated eventration? (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"swelling is expandable to cough","justification":""},{"idx":1,"correct":false,"proposition":"swelling is inflammatory","justification":""},{"idx":2,"correct":false,"proposition":"swelling is irregular","justification":""},{"idx":3,"correct":true,"proposition":"swelling is reducible","justification":""},{"idx":4,"correct":false,"proposition":"swelling is painful","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-7-qi-13","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" The patient asks you about this eventration, what can you tell her? (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"The risk of strangulation increases with the size of the collar","justification":""},{"idx":1,"correct":true,"proposition":"An intervention can be scheduled to close the parietal defect","justification":""},{"idx":2,"correct":false,"proposition":"spontaneous closure is still possible","justification":""},{"idx":3,"correct":true,"proposition":"ventration may increase in size over time","justification":""},{"idx":4,"correct":true,"proposition":"  An intervention prevents the risk of strangulation","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-7-qi-14","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" The patient prefers not to consider intervention. Five years later, she was referred to the emergency room for a sudden abdominal pain syndrome, associated with vomiting and stopping gas. On clinical examination, the abdomen is weathered, sensitive as a whole. The umbilical ventration has increased in volume, it is reducible. What is the most likely diagnosis? (only one answer expected)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Flanged occlusion","justification":""},{"idx":1,"correct":false,"proposition":"Recurrent appendicitis on stump","justification":""},{"idx":2,"correct":false,"proposition":"Recurrent peritonitis on appendicular stump release","justification":""},{"idx":3,"correct":false,"proposition":"Strangulation on ventration","justification":""},{"idx":4,"correct":false,"proposition":"hepatic colic","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-7-qi-15","context":"A 43-year-old patient, with no notable medical history, presents to the emergency room for severe abdominal pain that has been progressing for 48 hours. This pain began in the epigastric region and is located more precisely in the right iliac fossa. She vomited repeatedly. The vital parameters on arrival are: - temperature: 38.5 ° C - blood pressure: 95\/63 mmHg - heart rate: 106 bpm - SpO2 in ambient air: 97% - VAS of pain: 8\/10. Physical examination objective generalized abdominal contracture.","enonce":" The patient is operated urgently for a flange occlusion. It is not necessary to do digestive resection and the postoperative follow-up is simple. What information can you give to the patient post-operatively? (one or more correct answers)","item":"annales-2022-dp-7","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"A new occlusion is no longer to be feared because the flange has been severed","justification":""},{"idx":1,"correct":true,"proposition":"Eventration can still occur on the scars of this procedure","justification":""},{"idx":2,"correct":true,"proposition":"Low molecular weight heparin at a prophylactic dose is indicated postoperatively","justification":""},{"idx":3,"correct":false,"proposition":"Rapid resumption of oral feeding is possible with a residue-free diet during the 20 post-operative days","justification":""},{"idx":4,"correct":true,"proposition":" The resumption of transit is favored by the rapid resumption of physical activity","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-8-qi-1","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" With the elements of pulmonary auscultation that you have, what are the two most likely diagnostic hypotheses?","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"neuromuscular diseases","justification":""},{"idx":1,"correct":true,"proposition":"left heart failure","justification":""},{"idx":2,"correct":false,"proposition":"diffuse interstitial lung disease","justification":""},{"idx":3,"correct":false,"proposition":"asthma","justification":""},{"idx":4,"correct":true,"proposition":"chronic obstructive pulmonary disease (COPD)","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-8-qi-2","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" In the context of this chronic dyspnea, which additional examination(s) do you request in first line?","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"X-ray of standing chest","justification":""},{"idx":1,"correct":false,"proposition":"Chest CT angiography with pulmonary arterial time","justification":""},{"idx":2,"correct":false,"proposition":"D-Dimers","justification":""},{"idx":3,"correct":false,"proposition":"PET scanner","justification":""},{"idx":4,"correct":false,"proposition":"CRP","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-8-qi-3","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":"    CBC is normal. The chest x-ray requested is below.   As part of the assessment of this chronic dyspnea, you perform the following examination:","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"There is a disorder in the diffusion of carbon monoxide","justification":""},{"idx":1,"correct":false,"proposition":"there is reversibility of FEV1 after taking beta2 mimetics","justification":""},{"idx":2,"correct":false,"proposition":"The exam, to be interpretable, requires smoking cessation for at least two days.","justification":""},{"idx":3,"correct":false,"proposition":"the FEV1\/FVC ratio is not interpretable","justification":""},{"idx":4,"correct":true,"proposition":"there is chest distension","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-8-qi-4","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" You associate, in a second step, a plethysmography to the volume flow loop previously realized. What is (are) the additional information(s) provided by this review?","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"There is a disorder in the diffusion of carbon monoxide","justification":""},{"idx":1,"correct":true,"proposition":"It makes it possible to measure non-mobilizable lung volumes","justification":""},{"idx":2,"correct":true,"proposition":"total lung capacity is significantly increased","justification":""},{"idx":3,"correct":true,"proposition":"the residual volume is significantly increased","justification":""},{"idx":4,"correct":true,"proposition":"You can say that there is no restrictive syndrome","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-8-qi-5","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" In addition, to complete the EFRs, a carbon monoxide diffusion test (DLCO) was performed. It is 55% theoretical. Based on all the elements you now have available, what diagnosis(s) do you remember?","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"asthma","justification":""},{"idx":1,"correct":false,"proposition":"chronic bronchitis","justification":""},{"idx":2,"correct":true,"proposition":"chronic obstructive pulmonary disease (COPD)","justification":""},{"idx":3,"correct":false,"proposition":"amyotrophic lateral sclerosis","justification":""},{"idx":4,"correct":false,"proposition":"Hyperventilation syndrome","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-8-qi-6","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" This patient therefore suffers from COPD. What therapeutic strategy(s) can you implement at this stage as background treatment?","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"home nebulizations of short-acting beta2 mimetics","justification":"This proposal is unacceptable"},{"idx":1,"correct":true,"proposition":"inhaled treatment with a long-acting bronchodilator","justification":""},{"idx":2,"correct":false,"proposition":"inhaled therapy with a combination of two inhaled long-acting bronchodilators","justification":""},{"idx":3,"correct":false,"proposition":"inhaled therapy with a fixed combination of inhaled corticosteroid and long-acting beta2 mimetic","justification":"This proposal is also unacceptable."},{"idx":4,"correct":false,"proposition":"oral corticosteroids of 1 mg\/kg for 15 days before new EFRs","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-8-qi-7","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" Another essential step in its management is to consider quitting smoking as soon as possible. The patient seems motivated and asks you about nicotine substitutes. Regarding these nicotine substitutes, which is (are) the right answer(s)?","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"None of these nicotine substitutes are covered by health insurance","justification":""},{"idx":1,"correct":false,"proposition":"A cardiological assessment must be carried out prior to prescription","justification":""},{"idx":2,"correct":true,"proposition":"they have few side effects at recommended doses","justification":""},{"idx":3,"correct":true,"proposition":"their dosage must be adapted to the consumption of cigarettes","justification":""},{"idx":4,"correct":false,"proposition":"Only the cutaneous form by patch is effective","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-8-qi-8","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" The patient also described during questioning daytime asthenia responsible for a lack of enthusiasm and drowsiness that she considered normal. You mention the possibility of sleep apnea syndrome. The patient does not know if she is snoring. What signs do you look for besides daytime sleepiness to get arguments in favor of diagnosing sleep apnea syndrome? Give the answer(s) right.","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Uncontrollable cravings during the day","justification":""},{"idx":1,"correct":true,"proposition":"morning headaches","justification":""},{"idx":2,"correct":true,"proposition":"feelings of suffocation during sleep","justification":""},{"idx":3,"correct":true,"proposition":"difficulty concentrating","justification":""},{"idx":4,"correct":true,"proposition":"nocturnal polyuria","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-8-qi-9","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" You decide to make a ventilatory polygraph recording of which you have attached an extract of its nocturnal trace. What is (are) the exact answer(s)?","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"  This trace shows obstructive sleep apnea","justification":""},{"idx":1,"correct":false,"proposition":"This examination also includes an electroencephalogram","justification":""},{"idx":2,"correct":true,"proposition":"Oxygen saturation varies during this recording","justification":""},{"idx":3,"correct":false,"proposition":"This trace shows central sleep apnea","justification":""},{"idx":4,"correct":true,"proposition":"This plot shows that the thoraco-abdominal movements are in phase opposition during the phases of cessation of nasal flow","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-8-qi-10","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" After complete analysis of this recording, you were able to calculate a hypopnea apnea index greater than 60\/h. Give the right answer.","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"the patient is not obese, so you do not remember the diagnosis of obstructive sleep apnea syndrome","justification":""},{"idx":1,"correct":true,"proposition":"you are considering the installation of a continuous positive airway pressure device","justification":""},{"idx":2,"correct":false,"proposition":"you are considering hygiene measures alone for three months before a new inspection","justification":""},{"idx":3,"correct":false,"proposition":"you are considering a diuretic test before a new control at one month","justification":""},{"idx":4,"correct":false,"proposition":"you prescribe low doses of benzodiazepines","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-8-qi-11","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" She had recently benefited from a chest CT scan that she shows you. This confirms the predominant emphysema lesions at the top. This scanner also makes it possible to discover a nodule measured at 6 mm in its largest axis at the level of the lower left lobe (arrow). What are the criteria in favor of the benign nature of this nodule? Give the right answer(s)","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"its size","justification":""},{"idx":1,"correct":true,"proposition":"its regular contour","justification":""},{"idx":2,"correct":false,"proposition":"the patient's smoking","justification":""},{"idx":3,"correct":false,"proposition":"the diagnosis of COPD in this patient","justification":""},{"idx":4,"correct":false,"proposition":"the absence of calcification in its center","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-8-qi-12","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" Regarding the management of this nodule, what will you propose? (one or more correct answers)","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"positron emission tomography","justification":""},{"idx":1,"correct":false,"proposition":"a biopsy under CT scan","justification":""},{"idx":2,"correct":true,"proposition":"A scanner check in several months","justification":""},{"idx":3,"correct":false,"proposition":"an interferon release test even in the absence of tuberculosis contagion","justification":""},{"idx":4,"correct":false,"proposition":"Excision surgery from the outset","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-8-qi-13","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" A follow-up by control scanner was carried out. This monitoring is reassuring without any evolution of the nodule. Two years after initial management, the patient uses her continuous positive airway pressure (CPAP) machine very regularly and has benefited greatly symptomatically. His dyspnea is improved by taking a long-acting beta2-mimetic. She still pursues a smoking of the order of 5 cigarettes \/ day. She has no other comorbidities and is not taking any other treatment. Its EFRs are stable. You lose sight of it. She comes back to see you in consultation four years later because for about 3 days she has a worsening of her respiratory symptoms with an increase in dyspnea and the appearance of dirty sputum while she had no sputum before. Pulmonary auscultation findbilateral ronchi. The respiratory rate is 12\/min at rest. Air saturation is 96% at rest, there are no signs of respiratory distress. You prescribe appropriate antibiotic therapy. What other treatment(s) is (are) justified in the management of this COPD exacerbation? ","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"short-acting beta2 agonists","justification":"This proposal is essential"},{"idx":1,"correct":false,"proposition":"inhaled corticosteroids","justification":""},{"idx":2,"correct":false,"proposition":"home oxygen therapy to be re-evaluated in one month","justification":""},{"idx":3,"correct":false,"proposition":"oral corticosteroid therapy of 1 mg\/kg per day for 15 days","justification":"This proposal is unacceptable"},{"idx":4,"correct":false,"proposition":"non-invasive ventilation (NIV)","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-8-qi-14","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" It improves and returns to its basic state thanks to your treatment. In the following year she experienced at least two more similar episodes of COPD exacerbation. Her dyspnea is stage I of MRCD. To adapt his background treatment, what do you prescribe? Give the right answer(s)","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"inhaled therapy with a combination of two inhaled long-acting bronchodilators","justification":""},{"idx":1,"correct":true,"proposition":"inhaled therapy with a fixed combination of an inhaled corticosteroid and a long-acting beta2","justification":""},{"idx":2,"correct":false,"proposition":"inhaled therapy with a combination of two long-acting bronchodilators and an inhaled corticosteroid","justification":""},{"idx":3,"correct":false,"proposition":"oral corticosteroid therapy of 0.5 mg\/kg for one month before new EFRs","justification":""},{"idx":4,"correct":true,"proposition":"pulmonary rehabilitation","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-8-qi-15","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" You want the patient to undertake pulmonary rehabilitation. You have also prescribed inhaled treatment with a combination of an inhaled corticosteroid and a long-acting beta2-mimetic. What side effects are common with this type of inhaled treatment? Give the right answer(s)","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"dysphonia","justification":""},{"idx":1,"correct":true,"proposition":"Oral mycosis","justification":""},{"idx":2,"correct":false,"proposition":"peptic ulcer","justification":""},{"idx":3,"correct":true,"proposition":"tremors","justification":""},{"idx":4,"correct":false,"proposition":"systemic hypertension","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-8-qi-16","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" The patient continued to smoke for another two years and eventually stopped. She is 75 years old. Unfortunately very gradually his respiratory condition worsened and dyspnea only progressed. She is now dyspneic for moderate efforts of daily life. She had not wanted to do pulmonary rehabilitation. She has not had a new exacerbation for at least a year. You produce arterial blood gases at rest: pH 7.40; PaO 2 54 mmHg; PaCO2 42 mmHg; bicarbonates 26 mmol \/ l.Blood gases made three weeks apart under the same conditions are identical. She always puts on her CPAP well. You have achieved a nocturnal saturation that shows a regular pattern but a low saturation of the order of 89% all night. What can you conclude from the data you have available? Give the correct answer(s).","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"It's too late to consider pulmonary rehabilitation","justification":""},{"idx":1,"correct":false,"proposition":"It will be necessary to make a blood gas while she sleeps","justification":""},{"idx":2,"correct":false,"proposition":"It will be necessary to replace CPAP with nocturnal oxygen therapy","justification":""},{"idx":3,"correct":false,"proposition":"The patient is on an indication for ambulation oxygen therapy only","justification":""},{"idx":4,"correct":true,"proposition":"The patient is undergoing long-term oxygen therapy","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-8-qi-17","context":"You see a 65-year-old woman in consultation for the assessment of dyspnea. At the interrogation she complains of shortness of breath in everyday life and especially brisk walking flat. There is no cough and no expectoration. She smokes 10 cigarettes a day, with a smoking estimated at 50 pack-years. There is no notion of atopic terrain. She does not take any treatment. She had no particular occupational exposure. She has not had an acute respiratory episode for at least 10 years. She has not received an antibiotic for at least 4 or 5 years; It was, she recalls, for sinusitis. Pulmonary auscultation finds a vesicular murmur moderately decreased bilaterally with some sibilants. The rest of the clinical examination is considered normal. She weighs 65 kg and is 164 cm tall.","enonce":" The patient is undergoing long-term oxygen therapy. This will be implemented alone during the day and associated with CPAP at night. Give the correct answer(s) regarding long-term oxygen therapy.","item":"annales-2022-dp-8","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Its main purpose is to avoid the occurrence of right heart failure","justification":""},{"idx":1,"correct":true,"proposition":"It must be at least 15 hours out of 24","justification":""},{"idx":2,"correct":false,"proposition":"it will impose the institutionalization of the patient given her age","justification":""},{"idx":3,"correct":true,"proposition":"it will be necessary to ensure, during its implementation, that PaCO 2 remains stable","justification":""},{"idx":4,"correct":false,"proposition":"It is not covered by health insurance","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-9-qi-1","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" What can you conclude from these clinical elements? (one or more possible answers)","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"The clinical picture suggests polyarthritis","justification":""},{"idx":1,"correct":true,"proposition":"He has asthenia","justification":""},{"idx":2,"correct":true,"proposition":"The interrogation of his wife can provide elements of etiological orientation","justification":""},{"idx":3,"correct":true,"proposition":"the clinical picture is compatible with a depressive syndrome","justification":""},{"idx":4,"correct":true,"proposition":"An associated weight loss should be sought","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-9-qi-2","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" The weight in consultation is 68 kg. He announces a usual weight of 70 kg, relatively stable in recent years, and he has not recently changed his eating habits. It is 1.75 m tall. The body mass index (BMI) is 22.2 kg\/m2. Which proposal(s) is (are) the exact proposal(s)?","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"his weight loss corresponds to the definition of voluntary weight loss","justification":""},{"idx":1,"correct":false,"proposition":"his BMI corresponds to a phenotypic criterion of undernutrition","justification":""},{"idx":2,"correct":true,"proposition":"the presence of tachycardia would constitute an element of orientation","justification":""},{"idx":3,"correct":true,"proposition":"A sadness of mood must be sought","justification":""},{"idx":4,"correct":true,"proposition":"the existence of associated diarrhoea is a discriminating element of interrogation","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-9-qi-3","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" There is no mood sadness, or anything else in favor of a depressive syndrome. However, there has been a decrease in libido for several months. What question(s) should you ask to look for hypogonadism?","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"depilation","justification":""},{"idx":1,"correct":false,"proposition":"dysuria","justification":""},{"idx":2,"correct":true,"proposition":"erectile dysfunction","justification":""},{"idx":3,"correct":true,"proposition":"gynecomastia","justification":""},{"idx":4,"correct":false,"proposition":"increased muscle mass","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-9-qi-4","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" Mr. R. has erectile dysfunction, depilation, predominant in the lower limbs, as well as a diffuse brown coloration, especially of the face, neck, back of the hands, forearms, and oral mucosa. What biological abnormality(s) can be associated with the abnormal skin coloration observed in this patient?","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"low 8-hour cortisol level with high 8-hour plasma ACTH assay","justification":""},{"idx":1,"correct":false,"proposition":"increased 24-hour cortisoluria with low plasma ACTH assay","justification":""},{"idx":2,"correct":false,"proposition":"hypercalcemia with increased PTH","justification":""},{"idx":3,"correct":true,"proposition":"elevated transferrin saturation coefficient (TSC) with increased ferritin","justification":""},{"idx":4,"correct":false,"proposition":"Tricytopenia with increased erythropoietin","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-9-qi-5","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" The examination reveals a firm hepatomegaly at 2 finger crossings. The spleen is not palpable. You do not notice jaundice or stellar angioma. There is no abdominal collateral venous circulation. Abdominal percussion does not show dullness declivated. There is no palpable lymphadenopathy. Mr. R. consumes 3 glasses of red wine at the evening meal. What interpretation(s) can you make of this clinical picture? (one or more possible answers)","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"absence of signs of portal hypertension excludes hepatic cirrhosis","justification":""},{"idx":1,"correct":false,"proposition":"absence of signs of hepatocellular insufficiency excludes hepatic cirrhosis","justification":""},{"idx":2,"correct":true,"proposition":"It is necessary to look for hepatojugular reflux","justification":""},{"idx":3,"correct":false,"proposition":"the patient's BMI points to metabolic syndrome","justification":""},{"idx":4,"correct":false,"proposition":"The patient's daily consumption of pure alcohol is 15 grams per day","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-9-qi-6","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" The analyses show: ALT 105 IU\/L (normal: 8-35), AST 55 IU\/L (normal: 6-25), gamma-glutamyl-transpeptidase 60 IU\/L (normal < 40), alkaline phosphatase 173 IU\/L (normal: 35-105), TP 65%. The blood count is normal. A liver ultrasound shows hepatomegaly with hypertrophy of the left lobe and hepatic dysmorphism with heterogeneous parenchyma and irregularity of the hepatic contours (bumpy appearance). Absence of portal flow reversal or splenomegaly. Which exam(s) are you requesting?","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"hepatitis B serology","justification":""},{"idx":1,"correct":true,"proposition":"transferrin saturation coefficient","justification":""},{"idx":2,"correct":false,"proposition":"Anti-cytoplasmic antibodies of neutrophils","justification":""},{"idx":3,"correct":true,"proposition":"hepatitis C serology","justification":""},{"idx":4,"correct":true,"proposition":"anti-smooth muscle antibodies (anti-LKM1)","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-9-qi-7","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" In this patient, who most likely has cirrhosis, the biological assessment reveals: transferrin saturation coefficient 80%, ferritin 2450 μg \/ L, search for anti-HCV antibodies negative, HBs antigen: negative, anti-HBs antibodies: positive with rate at 100 IU \/ L, anti-HBc antibody: negative. Against this background, you also prescribe serum protein electrophoresis. What is your interpretation of this electrophoresis? (one or more correct answers) ","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"polyclonal hypergammaglobulinemia","justification":""},{"idx":1,"correct":false,"proposition":"monoclonal gammopathy","justification":""},{"idx":2,"correct":false,"proposition":"hyper-alpha2-globulinemia","justification":""},{"idx":3,"correct":true,"proposition":"beta-gamma block","justification":""},{"idx":4,"correct":true,"proposition":"hypoalbuminemia","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-9-qi-8","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" Which condition(s) or situation(s) could be responsible for the results of the martial assessment observed in this patient?","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"inflammatory syndrome","justification":""},{"idx":1,"correct":false,"proposition":"non-alcoholic steatohepatitis","justification":""},{"idx":2,"correct":false,"proposition":"rhabdomyolysis","justification":""},{"idx":3,"correct":true,"proposition":"Genetic hemochromatosis","justification":""},{"idx":4,"correct":false,"proposition":"hyperthyroidism","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-9-qi-9","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" You mention genetic hemochromatosis. Genetic analysis reveals a homozygous C282Y mutation in the HFE gene. Regarding the joint pain of which he complains, what elements would lead to an osteo-articular attack of his hemochromatosis? (one or more possible answers)","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Metacarpophalangeal involvement","justification":""},{"idx":1,"correct":true,"proposition":"Pseudo-gout attacks","justification":""},{"idx":2,"correct":false,"proposition":"erosion of distal interphalangeal","justification":""},{"idx":3,"correct":true,"proposition":"Radiological calcium border","justification":""},{"idx":4,"correct":true,"proposition":"  osteophytosis in hook of the heads of the metacarpals","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-9-qi-10","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" What examination(s) do you ask Mr. R to assess the possible impact of his hemochromatosis?","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"trans-thoracic cardiac ultrasound","justification":""},{"idx":1,"correct":false,"proposition":"coronary angiography","justification":""},{"idx":2,"correct":false,"proposition":"Whole body bone scintigraphy","justification":""},{"idx":3,"correct":true,"proposition":"testosteronemia","justification":""},{"idx":4,"correct":true,"proposition":"bone densitometry","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-9-qi-11","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" The results of the examinations are as follows:- trans-thoracic cardiac ultrasound: left ventricular ejection fraction 65%, normal filling pressures, undilated heart chambers, absence of valvular heart disease;- testosteronemia (total): 0.5 ng \/ mL (normal: 2.5 - 10); - vitamin D 10 ng \/ mL, serum calcium 2.2 mmol \/ L, phosphoremia 1.1 mmol \/ L;- bone densitometry: T-score at -2 at the lumbar spine, T-score at -1.8 at the femoral neck.- as a reminder,  the biological assessment has previously highlighted: transferrin saturation coefficient 80%, ferritin 2450 μg\/L, negative anti-HCV antibody test, HBs antigen: negative, anti-HBs antibodies: positive with 100 IU\/L level, anti-HBc antibodies: negative. What measure(s) should be put in place? ","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"vaccination against hepatitis B","justification":""},{"idx":1,"correct":false,"proposition":"vitamin C supplementation","justification":""},{"idx":2,"correct":true,"proposition":"vitamin D supplementation","justification":""},{"idx":3,"correct":true,"proposition":"Avoidance of alcohol","justification":""},{"idx":4,"correct":false,"proposition":"oral iron chelator","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-9-qi-12","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" Vitamin D supplementation is implemented, and you inform Mr. R of the importance of stopping alcohol consumption during pathology. You also start a depletive treatment with bloodletting. Regarding the methods, objectives and elements of bloodletting monitoring that you are going to set up at Mr. R, which is (are) accurate?","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Initially monthly rhythm in the attack phase","justification":""},{"idx":1,"correct":true,"proposition":"regular monitoring of ferritinemia","justification":""},{"idx":2,"correct":false,"proposition":"annual liver biopsy","justification":""},{"idx":3,"correct":true,"proposition":"suspension of bleeding if the blood haemoglobin test falls below 11 g\/dL","justification":""},{"idx":4,"correct":true,"proposition":"Initiation of bloodletting in a hospital setting","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-9-qi-13","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" Mr. R. asks you about the mechanisms behind his disease and iron metabolism. Which proposal(s) is(are) accurate?","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Iron absorption occurs mainly in the ileum","justification":""},{"idx":1,"correct":false,"proposition":"Hepcidin is increased during genetic hemochromatosis","justification":""},{"idx":2,"correct":true,"proposition":"Hepcidin inhibits the absorption of iron by the enterocyte","justification":""},{"idx":3,"correct":true,"proposition":"Hepcidin inhibits the release of iron by macrophages","justification":""},{"idx":4,"correct":false,"proposition":"Hepcidin is made by the kidney","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-9-qi-14","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" What genetic counseling will you offer Mr. R about his relatives? (one or more possible answers)","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"his 3 children must have a search for HFE mutation within the year","justification":""},{"idx":1,"correct":false,"proposition":"C282Y heterozygosity is associated with a minor form with moderate iron overload","justification":""},{"idx":2,"correct":true,"proposition":"his children have a one in 2 risk of being homozygous if his wife is heterozygous","justification":""},{"idx":3,"correct":true,"proposition":"Genetic testing in relatives is covered by health insurance","justification":""},{"idx":4,"correct":false,"proposition":"the attending physician should contact the patient's siblings for CST, ferritin and HFE genetic testing","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-9-qi-15","context":"Mr. R., 54 years old, comes to your consultation, accompanied by his wife. He has 3 healthy children aged 9, 14, and 17. He is a professor of life and earth sciences in college. He has never been operated on, and has a history of high blood pressure, for which he takes trandolapril 2 mg \/ day, as well as old joint pain of the hands, predominant in the morning, without joint swelling, without a diagnosis made. For several months, he has reported the appearance of unusual fatigue and weariness, affecting his professional and personal activities, and gradually worsening. Rest does not improve its symptoms.","enonce":" What follow-up exam(s) do you propose to Mr. R?","item":"annales-2022-dp-9","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"liver ultrasound every 6 months","justification":"This question has been rescinded"},{"idx":1,"correct":false,"proposition":"beta-2 microglobulin every 6 months","justification":"This question has been rescinded"},{"idx":2,"correct":true,"proposition":"blood count before bleeding","justification":"This question has been rescinded"},{"idx":3,"correct":false,"proposition":"Cardiac MRI with annual iron overload measurement","justification":"This question has been rescinded"},{"idx":4,"correct":true,"proposition":"regular gastro-duodenal endoscopy","justification":"This question has been rescinded"}],"type":"dp"}
+{"_id":"annales-2022-dp-10-qi-1","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" What is most suggestive of the central origin of facial paralysis?","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Asymmetry of the mouth with sagging of the labial commissure","justification":""},{"idx":1,"correct":true,"proposition":"Facial asymmetry more marked during voluntary movements than during automatic movements","justification":""},{"idx":2,"correct":false,"proposition":"Deviation of the tongue to the left during protraction","justification":""},{"idx":3,"correct":false,"proposition":"Sign of Souque's eyelashes during forced occlusion of the eyes","justification":""},{"idx":4,"correct":false,"proposition":"Left hearing loss","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-10-qi-2","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" What element(s) of favorable prognosis do you retain in this patient?","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Age","justification":""},{"idx":1,"correct":true,"proposition":"Incomplete upper limb deficit","justification":""},{"idx":2,"correct":false,"proposition":"The moderate nature of proprioceptive sensory disorders","justification":""},{"idx":3,"correct":true,"proposition":"The ability to sit still","justification":""},{"idx":4,"correct":false,"proposition":"The presence of swallowing disorders","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-10-qi-3","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" Given the clinical elements, which of the professionals mentioned below will you solicit?","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Physiotherapist","justification":""},{"idx":1,"correct":true,"proposition":"Occupational therapist","justification":""},{"idx":2,"correct":true,"proposition":"Speech therapist","justification":""},{"idx":3,"correct":false,"proposition":"Prosthetist","justification":""},{"idx":4,"correct":false,"proposition":"Podo-orthotist","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-10-qi-4","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" You have asked a physiotherapist, an occupational therapist and a speech therapist for the patient's rehabilitation program. After the speech-language pathologist has carried out an initial assessment, what elements will he have to work on to improve the patient's health? (one or more correct answers)","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"On the motor skills of the face","justification":""},{"idx":1,"correct":true,"proposition":"On the phases of swallowing","justification":""},{"idx":2,"correct":true,"proposition":"On the adaptation of meal textures","justification":""},{"idx":3,"correct":false,"proposition":"On the improvement of language disorders","justification":""},{"idx":4,"correct":true,"proposition":"On improving articulation","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-10-qi-5","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" His rehabilitation is going normally and you are planning a therapeutic weekend. Given the age and fragility of the patient, you are considering a nursing visit morning and evening. His wife asks you about the necessary elements for this therapeutic outing. She is also worried because the arrangements for her Sunday are not made. What information can you provide? (one or more exact propositions)","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Nursing care is covered by the health insurance fund","justification":""},{"idx":1,"correct":false,"proposition":"It will have to send the medical transport vouchers issued for the weekend to the departmental home for disabled people","justification":""},{"idx":2,"correct":true,"proposition":"If necessary, she can call her doctor or an emergency department during the weekend.","justification":""},{"idx":3,"correct":true,"proposition":"An occupational therapist will be able to best define with her the arrangements of her home","justification":""},{"idx":4,"correct":false,"proposition":"To make adjustments to her home, she will have to call on the departmental home for people with disabilities.","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-10-qi-6","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" Seven weeks after admission, the patient falls. He has left hip pain. The hospital student reports the data of his clinical examination to you. What proposals are compatible with a fracture of the upper end of the left femur? (one or more exact propositions)","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Absence of deformation","justification":""},{"idx":1,"correct":false,"proposition":"A vicious attitude in irreducible internal rotation","justification":""},{"idx":2,"correct":true,"proposition":"An externally rotating left lower limb","justification":""},{"idx":3,"correct":true,"proposition":"Shortening of the lower left limb","justification":""},{"idx":4,"correct":true,"proposition":"A left lower limb in adduction","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-10-qi-7","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" You ask for X-rays as follows:What is your diagnosis?","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"normal x-rays","justification":""},{"idx":1,"correct":true,"proposition":"basicervical fracture","justification":""},{"idx":2,"correct":false,"proposition":"Iliopubic branch fracture","justification":""},{"idx":3,"correct":false,"proposition":"Subtrochanteric fracture","justification":""},{"idx":4,"correct":false,"proposition":"Garden 1 cervical fracture","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-10-qi-8","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" The radiologist sends you his report with a diagnosis of coxarthrosis associated with a basicervical fracture. What proposals can treat both fracture and coxarthrosis? (one or more exact propositions)","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Head of spinal cord nailing","justification":""},{"idx":1,"correct":false,"proposition":"Osteosynthesis by dynamic plate screw","justification":""},{"idx":2,"correct":false,"proposition":"Intermediate hip replacement","justification":""},{"idx":3,"correct":true,"proposition":"Total hip replacement","justification":""},{"idx":4,"correct":false,"proposition":"Trans-skeletal traction","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-10-qi-9","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" The patient received a total left hip replacement. Postoperatively, he presented with a hematoma of the thigh that required the cessation of anticoagulation and the transfusion of 2 red blood cells. He is transferred to the neurological follow-up care unit with his blood type card. On arrival a biological assessment shows: albumin 35 g \/ L (34-50); Calcium 1.90 mmol\/L (2.08-2.65); serum folate 7.9 nmol\/L (normal if greater than 12); vitamin B12 371 pmol\/L (156-672); Ultrasensitive TSH 0.460 mIU\/L (0.400-4.00). In view of these elements and for the purpose of prevention, which of the following treatments are you prescribing immediately?","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Calcium","justification":""},{"idx":1,"correct":false,"proposition":"Alendronate","justification":""},{"idx":2,"correct":true,"proposition":"Vitamin d","justification":""},{"idx":3,"correct":false,"proposition":"Denosumab","justification":""},{"idx":4,"correct":false,"proposition":"Hormone therapy","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-10-qi-10","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" The patient is treated with calcium 1 g per day and vitamin D3 100,000 IU every 15 days for 3 months. Ten days after surgery a parapixaban treatment is resumed. Five days later, he has a very marked increase in the hematoma of the left thigh associated with a feeling of fatigue and a great mucocutaneous pallor. His blood pressure is at 100\/50mmHg his heart rate at 74 beats per minute. Its temperature is 37.2°C.What additional examinations do you prescribe urgently? (one or more exact propositions)","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Complete blood count","justification":""},{"idx":1,"correct":false,"proposition":"Pelvic X-ray","justification":""},{"idx":2,"correct":true,"proposition":"Thigh scanner","justification":""},{"idx":3,"correct":true,"proposition":"Search for irregular agglutinins","justification":""},{"idx":4,"correct":false,"proposition":"INR","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-10-qi-11","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" Faced with the situation you evoke acute bleeding and ask the nurse to urgently order 3 red blood cells. The search for irregular agglutinins is negative. Which proposal(s) apply to your patient?","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"you ask the patient for permission to consider a transfusion","justification":""},{"idx":1,"correct":false,"proposition":"you write a prescription for long-term illness (ALD) for 3 red blood cells","justification":""},{"idx":2,"correct":false,"proposition":"In this context of multiple transfusion you ask for compatible pellets","justification":""},{"idx":3,"correct":false,"proposition":"you check the patient's bedside Rhesus D compatibility with the Beth-Vincent test","justification":""},{"idx":4,"correct":false,"proposition":"You ask for irradiated red blood cells in front of this context of fragility","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-10-qi-12","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" When administering the third red blood cell, the nurse calls you because the patient shivers, and his temperature is at 39.2°C.What proposals apply to your patient? (one or more exact propositions)","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"You stop the transfusion without delay","justification":""},{"idx":1,"correct":true,"proposition":"You will need to make a haemovigilance declaration","justification":""},{"idx":2,"correct":true,"proposition":"You call the blood transfusion centre","justification":""},{"idx":3,"correct":true,"proposition":"You address the blood bag that passed at the time of the febrile episode to the laboratory according to the local procedure","justification":""},{"idx":4,"correct":true,"proposition":"You have blood cultures taken","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-10-qi-13","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" The bleeding episode is controlled and there were no other post-transfusion complications. The patient can resume walking after 3 weeks and is considering returning home. Which of the following suggestions concerning the information you should include on the physiotherapy prescription apply to your patient? (one or more exact propositions)","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"If the prescription is at home it must include the number of sessions","justification":""},{"idx":1,"correct":true,"proposition":"If the prescription is in the physiotherapist's office, it must include the mention \"physiotherapy treatments (or sessions)\"","justification":""},{"idx":2,"correct":false,"proposition":"If you want to insist on the recovery of hip joint amplitudes, you must precisely define on the prescription the number of sessions spent on this goal","justification":""},{"idx":3,"correct":true,"proposition":"If you want physiotherapy at home you must explicitly stipulate this on the prescription","justification":""},{"idx":4,"correct":true,"proposition":"If you want rehabilitation of the lower right limb and left hemiplegia you can register it on the same prescription","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-10-qi-14","context":"A patient, born in 1933, is admitted on June 30, 2021 to a physical medicine and rehabilitation ward after presenting a stroke on June 8, 2021. When examined, he has proportional left hemiplegia with partial recovery. It can voluntarily mobilize each part of the left hemibody against gravity. On the left, his reflexes are sharp, but he does not have an annoying pyramidal hypertonia. He is hampered by dysarthria due to significant left central facial paralysis. He has moderate proprioceptive disorders of the left hemibody. He sits comfortably alone at the edge of the bed. He can stand up with the help of a fixed support. He is able to walk in parallel bars but not yet with a cane. Her stroke was related to tight stenosis of the right internal carotid artery. An endarterectomy was performed on June 15, 2021. His attached brain scan shows ischemic damage to the oval center. The interrogation reveals three episodes of atrial self-limiting fibrillation, high blood pressure, hypercholesterolemia, type II diabetes, stable coronary artery insufficiency. Its entry treatment includes: apixaban effective dose, bisoprolol, metformin, slow insulin, amlodipine and perindopril, martial supplementation, alfuzosin. He has a mixed diet. The rehabilitation project is presented to him after assessment of the multidisciplinary team. He will perform daily, over a period of about 6 weeks, several rehabilitation activities related to his partial motor deficit. He should return home fairly quickly.","enonce":" You are considering home help. Which of the following proposals do you consider for your patient? (one or more exact proposals)","item":"annales-2022-dp-10","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Applying for a disabled adult allowance","justification":""},{"idx":1,"correct":true,"proposition":"Application for a personalized autonomy allowance","justification":""},{"idx":2,"correct":false,"proposition":"Applying for a special education allowance","justification":""},{"idx":3,"correct":false,"proposition":"Application for compensation benefit","justification":""},{"idx":4,"correct":true,"proposition":"Applying for a home help","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-12-qi-1","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" Controls report an initial loss of consciousness estimated at 2 minutes. The patient has a motor response adapted to simple commands, opens his eyes to demand, reveals his identity and is correctly located in time and space. The case is a 38-year-old man with no known medical history. How much do you estimate his score in Glasgow? (only one answer expected)","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"14","justification":""},{"idx":1,"correct":false,"proposition":"12","justification":""},{"idx":2,"correct":false,"proposition":"10","justification":""},{"idx":3,"correct":false,"proposition":"8","justification":""},{"idx":4,"correct":false,"proposition":"6","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-12-qi-2","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" You estimate the Glasgow score at 14.Which of the following proposition(s) is true for this patient?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"There is an indication of cranioencephalic CT","justification":""},{"idx":1,"correct":false,"proposition":"The score is modified by the existence of an initial loss of consciousness","justification":""},{"idx":2,"correct":true,"proposition":"The score must be reassessed upon arrival at the hospital","justification":""},{"idx":3,"correct":false,"proposition":"There is an indication for airway protection by intubation","justification":""},{"idx":4,"correct":true,"proposition":"The score could be altered by taking psychotropic drugs","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-12-qi-3","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" The patient mainly complains of pain in the right lower limb and right upper limb. In the right upper limb there is a deformity of the arm. The patient has functional impotence. You suspect a fracture of the humerus and seek to rule out paralysis of the radial nerve. To do this, what do you test specifically? (one or more correct answers)","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Altered sensitivity of the medial edge of the hand","justification":""},{"idx":1,"correct":false,"proposition":"Altered sensitivity of the thumb pulp","justification":""},{"idx":2,"correct":true,"proposition":"A deficit of active extension of the thumb","justification":""},{"idx":3,"correct":true,"proposition":"A deficit of active wrist extension","justification":""},{"idx":4,"correct":false,"proposition":"A deficit of active abduction\/adduction of long fingers","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-12-qi-4","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" At the level of the right knee, there is a large anterior wound, and a free bone fragment of the femoral condyle is externalized. Distal pulses are well perceived. Which of the following actions do you think is appropriate and to be implemented on the spot as a first intention?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Wound cleansing with an alcoholic antiseptic solution","justification":""},{"idx":1,"correct":true,"proposition":"Rinsing the wound with saline","justification":""},{"idx":2,"correct":false,"proposition":"Placing and tightening a tourniquet at the root of the thigh","justification":""},{"idx":3,"correct":true,"proposition":"Alignment of the lower limb in a splint","justification":""},{"idx":4,"correct":true,"proposition":"Moderately compressive sterile dressing","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-12-qi-5","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" The patient is unable to lift his leg by holding the knee in extension. A photograph of the wound is shown below. Which of the following applies?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"This is a joint wound","justification":""},{"idx":1,"correct":false,"proposition":"This is a punctiform wound","justification":""},{"idx":2,"correct":true,"proposition":"A rupture of the extender apparatus is suspected","justification":""},{"idx":3,"correct":true,"proposition":"The mobilization of the knee in flexion puts tension on the skin banks","justification":""},{"idx":4,"correct":true,"proposition":"Management of this wound requires extensive surgical debridement","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-12-qi-6","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" Haemodynamic stability of the patient was achieved with the infusion of 750 ml of crystalloid during transport. Which of the following anamnestic and clinical elements is (are) in favor of performing a whole body scan?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"The estimated speed at the time of the accident was 75 km\/h","justification":""},{"idx":1,"correct":false,"proposition":"The patient has a Glasgow score calculated at 14","justification":""},{"idx":2,"correct":false,"proposition":"There is a joint wound of the right knee","justification":""},{"idx":3,"correct":true,"proposition":"An evolution requiring the introduction of vasopressive amines","justification":""},{"idx":4,"correct":false,"proposition":"Seat belt use","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-12-qi-7","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" X-rays of the right knee front and profile as well as frontal reconstructions of the CT scan are attached. Which of the following is (are) correct?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"There is a fracture involving the tip of the patella","justification":""},{"idx":1,"correct":false,"proposition":"There is a supracondylar fracture of the distal femur","justification":""},{"idx":2,"correct":true,"proposition":"There is a fracture of the lateral femoral condyle","justification":""},{"idx":3,"correct":false,"proposition":"There is a fracture of the proximal metaphysis of the tibia","justification":""},{"idx":4,"correct":true,"proposition":" There is an ascent of the patella","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-12-qi-8","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" The whole body scanner finds no lesions other than those of the limbs. Injuries to the right knee and arm were managed in the operating room. At the knee, it was indeed a fracture of the lateral condyle, which was reinserted and osteosynthesized, and a fracture of the tip of the patella which was equivalent to an avulsion of the patellar ligament at the tip of the patella. Due to the articular nature of the lateral ducondyle fracture, you postpone the resumption of support during the 3rd postoperative month. To promote skin healing, you limit flexion to 90° during the first month after surgery. Post-operatively, you inform the patient of the progressive risks. What are the exact proposition(s) regarding the risk of postoperative stiffness?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"The limitation of the prescribed flexion is intended to promote the healing of the intra- and extra-articular elements","justification":""},{"idx":1,"correct":true,"proposition":"The intra-articular nature of the lesion increases the risk of stiffness","justification":""},{"idx":2,"correct":false,"proposition":"In the absence of complex regional pain syndrome type 1, there should be no loss of long-term mobility","justification":""},{"idx":3,"correct":true,"proposition":"The existence of a significant limitation of the flexion amplitude to 6 weeks after surgery may lead to discussion of mobilization under anesthesia","justification":""},{"idx":4,"correct":true,"proposition":"The persistence of stiffness beyond 3 months can be recovered by surgery","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-12-qi-9","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" For his rehabilitation, he is cared for in a follow-up care and rehabilitation department in a day hospital and wonders about the long-term goals of this treatment. Which of the following information(s) is (are) accurate and that you can give him?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"The knee will have to bend at least 110° for it to descend the stairs normally","justification":""},{"idx":1,"correct":true,"proposition":"A strengthening of the thigh muscles is necessary to ensure good stability in the phase of support to walking","justification":""},{"idx":2,"correct":true,"proposition":"The work of endurance to the effort will facilitate its resumption of activity","justification":""},{"idx":3,"correct":false,"proposition":"An evaluation of his workstation by the departmental home for disabled people will have to be organized","justification":""},{"idx":4,"correct":true,"proposition":"A regular assessment of participation restrictions will be made by a physical medicine and rehabilitation doctor throughout his recovery.","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-12-qi-10","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" Which of the following proposals is (are) the professional(s) who you think should be solicited for the rehabilitation of this patient?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"physiotherapist","justification":""},{"idx":1,"correct":true,"proposition":"occupational therapist","justification":""},{"idx":2,"correct":false,"proposition":"psychomotor therapist","justification":""},{"idx":3,"correct":false,"proposition":"Pedo-orthotist","justification":""},{"idx":4,"correct":true,"proposition":"Adapted physical activity teacher","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-12-qi-11","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" During the consultation he asks you about his professional future because he is worried. His accident is an accident at work (commuting accident). He has still not received daily allowance. Which of the following is (are) the exact answer(s)?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Knee pain may persist despite good consolidation","justification":""},{"idx":1,"correct":false,"proposition":"You confirm that his daily allowances will not be paid until he is released from hospital.","justification":""},{"idx":2,"correct":true,"proposition":"If he retains sequelae, he may request an evaluation which may give rise to compensation by the health insurance fund.","justification":""},{"idx":3,"correct":false,"proposition":"The adaptation of one's workstation may be carried out by the health insurance fund.","justification":""},{"idx":4,"correct":true,"proposition":"If necessary, the departmental home for disabled people may award him a certificate of disabled worker status.","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-12-qi-12","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" After two months, he was allowed to gradually resume support on the lower right limb. During follow-up, the patient complains of the gradual appearance of pain in the upper left limb, with an impression of numbness of the fingers. The phenomena are increased at the end of the day when he leans on his English cane. Which of the following elements of the clinical examination is (are) in favor of carpal tunnel syndrome?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Percussion next to the flexion fold of the wrist triggers pain","justification":""},{"idx":1,"correct":false,"proposition":"Painful phenomena increase when bending the elbow","justification":""},{"idx":2,"correct":false,"proposition":"Pain predominates in the last two fingers","justification":""},{"idx":3,"correct":true,"proposition":"Prolonged wrist flexion increases pain","justification":""},{"idx":4,"correct":false,"proposition":"  There is amyotrophy of the hypothenar eminence","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-12-qi-13","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" The situation does not improve despite the gradual abandonment of the English cane on the left with persistent pain and paresthesias in the left hand. You suspect a comprehension of the ulnar nerve. What test do you prescribe to determine its location and impact? (only one answer expected)","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Ultrasound of the wrist","justification":""},{"idx":1,"correct":false,"proposition":"X-rays of the elbow and wrist","justification":""},{"idx":2,"correct":true,"proposition":"Comparative electroneuromyogram of the two upper limbs","justification":""},{"idx":3,"correct":false,"proposition":"Dynamic X-rays of the cervical spine","justification":""},{"idx":4,"correct":false,"proposition":"Cervical MRI","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-12-qi-14","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" The electromyogram confirmed compression of the ulnar nerve but the symptoms gradually improved with the disappearance of paresthesia. The evolution of pain and strength was favorable to the lower right limb after 4 months of rehabilitation but he remains embarrassed for the descent of the stairs because the flexion of the knee reaches only 100 °. However, you are concerned because it retains pain in the upper right limb. Yet you notice a very good evolution both in the strength and amplitudes of the shoulder and elbow which have returned to normal. You gave him a prescription for physiotherapy sessions without specifying the number. Among the following proposals, which is (are) the one (s) you can make for his outpatient follow-up?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Physiotherapy may also be accompanied by balneotherapy despite the absence of specific mention on the prescription","justification":""},{"idx":1,"correct":false,"proposition":"The conditions of management of occupational therapy are no different from physiotherapy-balneotherapy","justification":""},{"idx":2,"correct":true,"proposition":"The physiotherapist will be able to adapt the number of sessions by himself without this posing any problem of coverage by the social security","justification":""},{"idx":3,"correct":false,"proposition":"It is not necessary to see the surgeon again before 18 months given the severity of the fractures","justification":""},{"idx":4,"correct":false,"proposition":"Physiotherapy can be performed at home despite the absence of specific mention on the prescription","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-12-qi-15","context":"You intervene on the scene of an accident on the public road. According to witnesses, the accident occurred 10 minutes earlier. Witnesses report a head-on collision at the entrance to a built-up area, between a pickup truck and a light vehicle. You take charge of the driver of the van. He was wearing a seat belt.","enonce":" Since the patient fails to carry a load on the right side at 6 months postoperatively, you decided to refer him back to the surgeon. Here is the radiographic aspect on front and profile images. Which proposal(s) is (are) true?","item":"annales-2022-dp-12","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"This is hypertrophic pseudarthrosis","justification":""},{"idx":1,"correct":true,"proposition":"The chances of spontaneous consolidation at this stage are minimal in the absence of intervention","justification":""},{"idx":2,"correct":false,"proposition":"This is the normal course of a fracture after osteosynthesis.","justification":""},{"idx":3,"correct":false,"proposition":"This is a vicious aspect of callus","justification":""},{"idx":4,"correct":true,"proposition":"The osteosynthesis material in place is a centromedullary nail","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-13-qi-1","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" What do you think is the most important thing to collect during questioning? (only one answer expected)","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"a family history of systemic inflammatory disease","justification":""},{"idx":1,"correct":false,"proposition":"A triggering factor","justification":""},{"idx":2,"correct":false,"proposition":"a cardiovascular history","justification":""},{"idx":3,"correct":false,"proposition":"A recent trip","justification":""},{"idx":4,"correct":true,"proposition":"the pain schedule","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-13-qi-2","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" What is (are) the element(s) that orient you towards an inflammatory nature of pain?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Awakenings at the end of the night","justification":""},{"idx":1,"correct":false,"proposition":"difficulty falling asleep","justification":""},{"idx":2,"correct":false,"proposition":"10-minute morning stiffness","justification":""},{"idx":3,"correct":true,"proposition":"persistence of pain at rest","justification":""},{"idx":4,"correct":false,"proposition":"progressive worsening of pain during the day","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-13-qi-3","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" Joint pain is inflammatory. What are the three most likely diagnoses in this patient to explain all the symptoms?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"rheumatoid arthritis","justification":""},{"idx":1,"correct":true,"proposition":"scleroderma","justification":""},{"idx":2,"correct":false,"proposition":"a drop","justification":""},{"idx":3,"correct":true,"proposition":"lung cancer","justification":""},{"idx":4,"correct":false,"proposition":"myeloma","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-13-qi-4","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" Your clinical examination objective the abnormalities visualized in the following photograph. What do you suspect (one or more possible answers)?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Tophus","justification":""},{"idx":1,"correct":true,"proposition":"rheumatoid nodules","justification":""},{"idx":2,"correct":false,"proposition":"erythema nodosum","justification":""},{"idx":3,"correct":false,"proposition":"Heberden's nodules","justification":""},{"idx":4,"correct":false,"proposition":"multiple abscesses","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-13-qi-5","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" You prescribe a biological assessment. Which of the following proposals do you think is relevant at this stage?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"HLA typing","justification":""},{"idx":1,"correct":true,"proposition":"CRP","justification":""},{"idx":2,"correct":false,"proposition":"Antiphospholipid antibodies","justification":""},{"idx":3,"correct":true,"proposition":"anti-citrullinated peptide (ACPA) antibodies","justification":""},{"idx":4,"correct":true,"proposition":"anti-nuclear antibodies","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-13-qi-6","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" The immunological assessment shows: negative anti-citrullinated peptide antibodies (ACPA), anti-nuclear antibodies positive at 1\/80 without specificity, a rheumatoid factor positive. CRP is 60 mg\/L.Given all the clinical and paraclinical information available at this stage, what is the most likely diagnosis?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"a drop","justification":""},{"idx":1,"correct":true,"proposition":"rheumatoid arthritis","justification":""},{"idx":2,"correct":false,"proposition":"psoriatic arthritis","justification":""},{"idx":3,"correct":false,"proposition":"lupus","justification":""},{"idx":4,"correct":false,"proposition":"scleroderma","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-13-qi-7","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" Faced with this distal, bilateral and symmetrical polyarthritis, the presence of rheumatoid nodules and the positivity of rheumatoid factor, you have made the diagnosis of rheumatoid arthritis and started a background treatment with methotrexate. The patient has progressive dyspnea stage 2 on the modified Medical Research Council (mMRC) scale that has been on for six months now. The objective auscultation of the dry crackling of the two bases. The rest of the chest examination is normal. The heart rate is regular without any particular breath. What do you suspect first (only one answer expected)?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"chronic bronchitis","justification":""},{"idx":1,"correct":false,"proposition":"pleural effusion","justification":""},{"idx":2,"correct":false,"proposition":"infectious pneumonia","justification":""},{"idx":3,"correct":true,"proposition":"diffuse interstitial lung disease","justification":""},{"idx":4,"correct":false,"proposition":"diaphragmatic paralysis","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-13-qi-8","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" Faced with this suspicion of diffuse interstitial lung disease, what are the two most relevant complementary examinations?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"bronchial fibroscopy with LBA","justification":""},{"idx":1,"correct":true,"proposition":"EFRs with DLCO measurement","justification":""},{"idx":2,"correct":true,"proposition":"a chest CT scan","justification":""},{"idx":3,"correct":false,"proposition":"echocardiography","justification":""},{"idx":4,"correct":false,"proposition":"a pulmonary ventilation\/perfusion scan","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-13-qi-9","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" You complete your approach by performing a chest CT scan, a section of which is attached. What basic lesion(s) do you observe on this scanner?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"pleural effusion","justification":""},{"idx":1,"correct":false,"proposition":"condensation erasing vascular structures","justification":""},{"idx":2,"correct":false,"proposition":"micronodules","justification":""},{"idx":3,"correct":true,"proposition":"intralobular cross-linking","justification":""},{"idx":4,"correct":true,"proposition":"traction bronchiectasis","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-13-qi-10","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" You perform pulmonary function tests:What is (are) the exact answer(s)?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Diffusion disorder","justification":""},{"idx":1,"correct":false,"proposition":"obstructive syndrome","justification":""},{"idx":2,"correct":true,"proposition":"restrictive syndrome","justification":""},{"idx":3,"correct":false,"proposition":"Significant reversibility","justification":""},{"idx":4,"correct":false,"proposition":"shunt","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-13-qi-11","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" You are diagnosed with diffuse interstitial lung disease related to rheumatoid arthritis. Two years later, on the blood test, isolated neutropenia was found at 789\/mm3. The patient is asthenic. He has no fever. On examination, you find splenomegaly. Which diagnosis do you think is most likely?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"rheumatoid vasculitis","justification":""},{"idx":1,"correct":false,"proposition":"schistosomiasis","justification":""},{"idx":2,"correct":false,"proposition":"Gaucher disease","justification":""},{"idx":3,"correct":false,"proposition":"hairy cell leukemia","justification":""},{"idx":4,"correct":true,"proposition":"Felty's syndrome","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-13-qi-12","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" You are diagnosed with Felty's syndrome. The patient is now being treated with immunosuppressants. He contacts you again after 3 months of treatment due to a worsening of dyspnea for two days with dyspnea at the slightest effort. The respiratory rate is 35 cycles per minute, hemodynamics are stable. Saturation is 95% under 6 liters of oxygen per minute. Pulmonary auscultation finds bilateral crackling at the bases. Vocal vibrations are unchanged and chest percussion is normal. What are the three diagnoses that you first mention in the face of this brutal decompensation?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"pulmonary embolism","justification":""},{"idx":1,"correct":false,"proposition":"lung cancer","justification":""},{"idx":2,"correct":false,"proposition":"pneumothorax","justification":""},{"idx":3,"correct":true,"proposition":"pneumocystosis","justification":""},{"idx":4,"correct":true,"proposition":"community-acquired acute pneumonia","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-13-qi-13","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" Given the severity of the patient, you hospitalize him. The temperature is 38.6°C.  An X-ray of the chest in bed is performed while sitting. What do you see? (one or more correct answers)","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"right pleural effusion","justification":""},{"idx":1,"correct":false,"proposition":"left apical pneumothorax","justification":""},{"idx":2,"correct":false,"proposition":"cardiomegaly","justification":""},{"idx":3,"correct":true,"proposition":"Alveolar opacities on the left","justification":""},{"idx":4,"correct":true,"proposition":"Bilateral interstitial opacities","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-13-qi-14","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" Severity criteria dictate that you transfer your patient to critical care. What sample(s) do you take to make the microbiological diagnosis of this infectious pneumonitis?","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Legionella antigenuria","justification":""},{"idx":1,"correct":true,"proposition":"Blood","justification":""},{"idx":2,"correct":true,"proposition":"Multiplex PCR on nasopharyngeal swab","justification":""},{"idx":3,"correct":true,"proposition":"cytobacteriological examination of sputum","justification":""},{"idx":4,"correct":true,"proposition":"pneumococcal antigenuria","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-13-qi-15","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" While waiting for microbiological results, which probabilistic antibiotic therapy do you prescribe? (one or more correct answers)","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Spiramycin intravenously","justification":""},{"idx":1,"correct":false,"proposition":"intravenous amoxicillin","justification":""},{"idx":2,"correct":true,"proposition":"intravenous cefotaxime","justification":""},{"idx":3,"correct":false,"proposition":"Intravenous ciprofloxacin","justification":""},{"idx":4,"correct":false,"proposition":"intravenous metronidazole","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-13-qi-16","context":"A 67-year-old patient consults for polyarthralgia of both hands evolving for 6 months. These polyarthralgia are symmetrical, affecting the metacarpophalangeal joints and proximal interphalangeal joints. He also reports dyspnea of exertion appeared concomitantly. Its history includes active smoking at 40 pack-years.","enonce":" The microbiological balance is negative. Nevertheless, the patient's course is favorable after 7 days of treatment with cefotaxime and spiramycin. The patient returns home but is unable to leave easily due to fatigue. It retains bronchial congestion. You decide to continue chest physiotherapy. What elements must be included on the prescription? (one or more correct answers)","item":"annales-2022-dp-13","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"the mention << home physiotherapy>>","justification":""},{"idx":1,"correct":false,"proposition":"the number of sessions you plan","justification":""},{"idx":2,"correct":false,"proposition":"diagnosis and type of pneumonia","justification":""},{"idx":3,"correct":false,"proposition":"the frequency of sessions per week","justification":""},{"idx":4,"correct":true,"proposition":"the mention << seven days a week>> if you consider weekend care necessary","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-14-qi-1","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" Faced with this complicated fall from a head trauma, what elements justify the realization of an emergency brain scan? (one or more correct answers)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Age","justification":""},{"idx":1,"correct":false,"proposition":"Suspected syncope","justification":""},{"idx":2,"correct":true,"proposition":"Taking anticoagulant","justification":""},{"idx":3,"correct":true,"proposition":"Confusion","justification":""},{"idx":4,"correct":false,"proposition":"Polypathology","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-14-qi-2","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" Which proposals are correct regarding the brain scan? (one or more correct answers)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Old bifrontal subdural collection","justification":""},{"idx":1,"correct":true,"proposition":"Subcortical atrophy","justification":""},{"idx":2,"correct":false,"proposition":"Signs of intracranial hypertension","justification":""},{"idx":3,"correct":true,"proposition":"Recent subdural hemorrhage","justification":""},{"idx":4,"correct":false,"proposition":"Right occipital old ischemic sequelae","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-14-qi-3","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" Among the tests requested, the INR is 2.1. What therapeutic measures are you putting in place regarding anticoagulant treatment? (one or more possible answers)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"  Intravenous vitamin K prescription","justification":""},{"idx":1,"correct":true,"proposition":"Prescription of concentrate of prothrombin complexes","justification":""},{"idx":2,"correct":true,"proposition":"Discontinuation of coumadin treatment","justification":""},{"idx":3,"correct":false,"proposition":"Prescription of an antiplatelet agent","justification":""},{"idx":4,"correct":false,"proposition":"Prescription of a low molecular weight heparin at a prophylactic dose","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-14-qi-4","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" You stop coumadin, inject vitamin K and concentrate of prothrombin complexes intravenously. What monitoring measures do you put in place? (one or more correct answers)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Platelet count at 30 minutes","justification":""},{"idx":1,"correct":true,"proposition":"INR check at 30 minutes","justification":""},{"idx":2,"correct":false,"proposition":"Anti-Xa activity","justification":""},{"idx":3,"correct":true,"proposition":"INR control at 6 a.m.","justification":""},{"idx":4,"correct":false,"proposition":"Factor V assay at 6 o'clock","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-14-qi-5","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" The controlled INR at 30 minutes is 1.1. As part of the exploration of the patient's chest pain, you perform an ECG and chest X-ray. What etiological diagnosis do you retain for this chest pain? (only one exact answer)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Pulmonary embolism","justification":""},{"idx":1,"correct":false,"proposition":"Pneumonia of the right base","justification":""},{"idx":2,"correct":true,"proposition":"Rib fracture","justification":""},{"idx":3,"correct":false,"proposition":"Pneumothorax","justification":""},{"idx":4,"correct":false,"proposition":"Acute coronary syndrome","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-14-qi-6","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" Biologically, you note a natremia at 128 mmol \/ L. What additional elements can be used to explore this result? (one or more correct answers)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Urinary ionogram","justification":""},{"idx":1,"correct":true,"proposition":"Protidemia","justification":""},{"idx":2,"correct":false,"proposition":"Serum anti-diuretic hormone assay","justification":""},{"idx":3,"correct":false,"proposition":"Total cholesterolemia","justification":""},{"idx":4,"correct":false,"proposition":"Proteinuria","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-14-qi-7","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" Protein and blood sugar are normal. The appearance of the serum is normal. You conclude hypoosmotic hyponatremia.   Kidney function is normal. The urinary ionogram reveals: natriuresis 60 mmol \/ L; kaliuresis 30 mmol\/L; urinary urea 250 mmol\/L.What are the two etiologies you mention at this stage?","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Syndrome of inappropriate DHA secretion related to serotonin reuptake inhibitor therapy","justification":""},{"idx":1,"correct":true,"proposition":"Syndrome of inappropriate DHA secretion related to chronic subdural hematoma","justification":""},{"idx":2,"correct":false,"proposition":"Potomania","justification":""},{"idx":3,"correct":false,"proposition":"Water retention related to calcium channel blocker treatment","justification":""},{"idx":4,"correct":false,"proposition":"Syndrome of inappropriate DHA secretion related to pleural effusion","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-14-qi-8","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" What therapeutic measures do you take with regard to this hyponatremia? (one or more correct answers)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Water restriction","justification":""},{"idx":1,"correct":false,"proposition":"NaCl infusion 9‰ 1000 ml\/24h","justification":""},{"idx":2,"correct":false,"proposition":"Treatment with loop diuretic","justification":""},{"idx":3,"correct":false,"proposition":"Sodium intake per os at 12 g \/ 24 hours","justification":""},{"idx":4,"correct":true,"proposition":"Discontinuation of serotonin reuptake inhibitor therapy","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-14-qi-9","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" You suspect syncope. Returning to the interrogation, the patient's daughter tells you that this is the second episode of sudden discomfort in a month, but her mother was not injured last time. What abnormalities do you notice on the ECG (same trace as question 5)? (one or more possible answers)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Full left branch block","justification":""},{"idx":1,"correct":true,"proposition":"Full right branch block","justification":""},{"idx":2,"correct":true,"proposition":"Left anterior hemiblock","justification":""},{"idx":3,"correct":false,"proposition":"Left posterior hemiblock","justification":""},{"idx":4,"correct":false,"proposition":"Atrial fibrillation","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-14-qi-10","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" What diagnosis do you mention in priority in this patient regarding the etiology of her syncopes?","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Tight aortic stricture","justification":""},{"idx":1,"correct":false,"proposition":"Severe pulmonary embolism","justification":""},{"idx":2,"correct":true,"proposition":"Atrioventricular block of the paroxysmal 3rd degree","justification":""},{"idx":3,"correct":false,"proposition":"Paroxysmal ventricular tachycardia","justification":""},{"idx":4,"correct":false,"proposition":"Orthostatic hypotension","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-14-qi-11","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" Since her admission, the patient has spoken incoherently. The neurological condition is different from the usual state according to her daughter. What elements will you look for in favor of a delirium syndrome? (one or more correct answers)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Fluctuations in unrest","justification":""},{"idx":1,"correct":false,"proposition":"Absences","justification":""},{"idx":2,"correct":true,"proposition":"Language disorders","justification":""},{"idx":3,"correct":true,"proposition":"Amnesia","justification":""},{"idx":4,"correct":true,"proposition":"Visual hallucinations","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-14-qi-12","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" You are diagnosing confusion. What factors do you mention to explain the appearance of delirium syndrome? (one or more correct answers)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Subdural hematoma","justification":""},{"idx":1,"correct":true,"proposition":"Head trauma","justification":""},{"idx":2,"correct":false,"proposition":"Depressive syndrome","justification":""},{"idx":3,"correct":true,"proposition":"Chest pain","justification":""},{"idx":4,"correct":false,"proposition":"Sleep disorders","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-14-qi-13","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" What therapeutic measure(s) are you putting in place regarding this delirium syndrome?","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Continued treatment with benzodiazepine at the same dosage","justification":""},{"idx":1,"correct":false,"proposition":"Melatonin addition","justification":""},{"idx":2,"correct":false,"proposition":"Increased benzodiazepine treatment to cover nycthémère","justification":""},{"idx":3,"correct":true,"proposition":"Daily reminders on temporo-spatial orientation","justification":""},{"idx":4,"correct":true,"proposition":"Analgesic treatment with paracetamol","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-14-qi-14","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" The patient presents with significant false routes to saliva and during the water test. His daughter tells you that her mother had no difficulty swallowing her meals before this fall. What complications can occur because of these swallowing disorders? (one or more correct answers)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Undernutrition","justification":""},{"idx":1,"correct":true,"proposition":"Death","justification":""},{"idx":2,"correct":false,"proposition":"Dysarthria","justification":""},{"idx":3,"correct":true,"proposition":"Pneumonia","justification":""},{"idx":4,"correct":false,"proposition":"Aphasia","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-14-qi-15","context":"You take care of an 85-year-old patient in the emergency room for a fall with head trauma. The patient is accompanied by her daughter with whom she has been living for two years. She witnessed the fall eight hours ago, and describes a brutal fall forward, from her height, with loss of consciousness. When she approached her mother after the fall, she seemed lost, anxious and her ideas were muddled, and this is still going on. She found nothing else. She called the fire department who brought her to the emergency room. She gives you the prescription of her usual treatments including coumadin for paroxysmal atrial fibrillation, amlodipine and valsartan for old high blood pressure, paroxetine for a depressive syndrome, alprazolam in the evening for anxiety disorders and old sleep disorders. On clinical examination, the patient reported right chest pain. Blood pressure is at 130\/75 mmHg, heart rate at 90\/min, you do not notice motor neurological deficit, sensitivity is difficult to assess because the patient seems confused. Capillary blood sugar is normal. She is not thirsty and the examination does not objectify dryness of the mucous membranes or edematous syndrome. The patient has a 2\/6, holosystolic, vapor jet murmur, and pulmonary auscultation is normal.","enonce":" What measures do you put in place to avoid complications related to swallowing disorders? (one or more correct answers)","item":"annales-2022-dp-14","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Meals in the supine position at 45 °","justification":""},{"idx":1,"correct":true,"proposition":"Meal with head tilted forward","justification":""},{"idx":2,"correct":true,"proposition":"Cold drinks","justification":""},{"idx":3,"correct":true,"proposition":"Drinks","justification":""},{"idx":4,"correct":false,"proposition":"Food with small pieces","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-15-qi-1","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" What semiological elements are present in this patient? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"A fatigability suggestive of diabetic neuropathy","justification":""},{"idx":1,"correct":true,"proposition":"pyramidal syndrome","justification":""},{"idx":2,"correct":false,"proposition":"mowing","justification":""},{"idx":3,"correct":true,"proposition":"peripheral neurological clinical syndrome","justification":""},{"idx":4,"correct":false,"proposition":"myasthenic syndrome","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-15-qi-2","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" This patient has signs and symptoms consistent with diabetic neuropathy. Which ones are compatible with this diagnosis? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"  Very lively and diffused patellar tendon reflexes","justification":""},{"idx":1,"correct":true,"proposition":"Normal tendon reflexes in the upper limbs","justification":""},{"idx":2,"correct":true,"proposition":"Abolished Achileo tendon reflexes","justification":""},{"idx":3,"correct":true,"proposition":"Hypoaesthesia of both feet","justification":""},{"idx":4,"correct":false,"proposition":"Unilateral sensory deficit up to the umbilicus","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-15-qi-3","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" To confirm the lesional location that best explains the clinical picture, which additional examination is most relevant? (only one answer expected)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Bone marrow MRI","justification":""},{"idx":1,"correct":false,"proposition":"Electroneuromyogram","justification":""},{"idx":2,"correct":false,"proposition":"Brain MRI","justification":""},{"idx":3,"correct":false,"proposition":"Driving evoked potentials","justification":""},{"idx":4,"correct":false,"proposition":"Spinal scanner","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-15-qi-4","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" You have requested a spinal cord MRI :P the following proposals, which ones are correct? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"This is a coronal cup","justification":""},{"idx":1,"correct":true,"proposition":"An intramedullary hypersignal is observed next to thoracic vertebrae","justification":""},{"idx":2,"correct":true,"proposition":"The intramedullary signal suggests an inflammatory lesion","justification":""},{"idx":3,"correct":true,"proposition":"This is a T2-weighted cut","justification":""},{"idx":4,"correct":false,"proposition":"  There is a mass effect on the spinal cord","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-15-qi-5","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" In the light of the inflammatory involvement of the dorsal marrow in relation to the 5th thoracic vertebra, what additional examinations could confirm the etiology of this central neurological disease? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Brain MRI","justification":""},{"idx":1,"correct":false,"proposition":"Electroneuromyogram","justification":""},{"idx":2,"correct":false,"proposition":"Somesthetic evoked potentials","justification":""},{"idx":3,"correct":true,"proposition":"Microbiological","justification":""},{"idx":4,"correct":false,"proposition":"Serum CRP assay","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-15-qi-6","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" A brain MRI is performed. It is an MRI in axial section weighted in T2 at the subtentorial level and axial FLAIR at the supratentorial level. Which of the following are true? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Abnormal images are visualized in hyposignal","justification":""},{"idx":1,"correct":false,"proposition":"Hypersignals suggest multiple metastatic lesions","justification":""},{"idx":2,"correct":true,"proposition":"At least one subcortical lesion is visualized","justification":""},{"idx":3,"correct":true,"proposition":" At least one periventricular lesion is visualized","justification":""},{"idx":4,"correct":true,"proposition":" The largest lesion, in subtentorial, affects a cerebellar peduncle","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-15-qi-7","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" A study of cerebrospinal fluid was performed. The main results are as follows:P roteinorachia: 0.68 g \/ LCellules: 0 red blood cells; 6 mononuclear cellsGlycorachia: 0.90 g \/ LIndex IgG: 0.92Oligoclonal appearance with at least 9 supernumerary bands of IgG.Regarding this analysis of cerebrospinal fluid, what are the exact answers? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Proteinrachia is normal","justification":""},{"idx":1,"correct":true,"proposition":"There is an intrathecal synthesis of IgG","justification":""},{"idx":2,"correct":false,"proposition":"There are arguments in favor of bacterial meningitis","justification":""},{"idx":3,"correct":true,"proposition":"Elevated glycorachia is compatible with the context of diabetes","justification":""},{"idx":4,"correct":true,"proposition":"Cellularity is compatible with a diagnosis of multiple sclerosis","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-15-qi-8","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" What diagnoses do you retain to explain all the clinical, radiological and biological data in this file? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Intramedullary tumour","justification":""},{"idx":1,"correct":true,"proposition":"Polyneuropathy","justification":""},{"idx":2,"correct":false,"proposition":"Biermer's disease","justification":""},{"idx":3,"correct":true,"proposition":"Multiple sclerosis","justification":""},{"idx":4,"correct":false,"proposition":"Acute polyradiculoneuritis","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-15-qi-9","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" In addition to a picture of polyneuropathy, this patient has multiple sclerosis (MS). You tell him this diagnosis. He asks you questions about MS. Which of the following are true? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"The primary progressive form is more common in the beginning of the disease","justification":""},{"idx":1,"correct":true,"proposition":"MS is more common in Caucasian women","justification":""},{"idx":2,"correct":true,"proposition":"The presence of cognitive disorders, during illness, is common","justification":""},{"idx":3,"correct":false,"proposition":"The association of MS and type I diabetes is linked to chance","justification":""},{"idx":4,"correct":true,"proposition":"The risk of MS in siblings is increased compared to the general population","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-15-qi-10","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" During his medical follow-up, the patient reports a few months later to be constipated. He sometimes needs to empty his bladder in two or three steps. His libido is diminished. Which of the following are true? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"The patient has symptoms of overactive bladder","justification":""},{"idx":1,"correct":true,"proposition":"The post-voiding residue must be measured","justification":""},{"idx":2,"correct":false,"proposition":"You first mention prostatic hypertrophy","justification":""},{"idx":3,"correct":false,"proposition":"The decrease in libido is directly related to his spinal cord damage","justification":""},{"idx":4,"correct":true,"proposition":"Constipation may be related to MS","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-15-qi-11","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" In general, regarding neuroperineal disorders, which proposals are accurate? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Overactive bladder is mainly manifested by voiding emergencies","justification":""},{"idx":1,"correct":false,"proposition":"First-line drug therapy for overactive bladder relies on alpha-blockers","justification":""},{"idx":2,"correct":true,"proposition":"  Dysuria can be confirmed by flowmetry","justification":""},{"idx":3,"correct":true,"proposition":"In case of post-voiding residues, intermittent self-sounding should be preferred.","justification":""},{"idx":4,"correct":true,"proposition":"Both multiple sclerosis and diabetes can impair erectile abilities","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-15-qi-12","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" This patient has primary progressive MS. It has no background treatment. You see him again six months later. He tells you that he has been feeling particularly tired for a few months and that he is << stiff >>. You observe spasticity of the posterior laloge of the right leg. What support do you offer? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"You are initiating corticosteroid therapy with prednisolone","justification":""},{"idx":1,"correct":false,"proposition":"You contraindicate the resumption of physical activity","justification":""},{"idx":2,"correct":true,"proposition":"You are discussing an antispastic treatment (baclofene)","justification":""},{"idx":3,"correct":false,"proposition":"You gradually introduce pregabalin therapy","justification":""},{"idx":4,"correct":true,"proposition":"You prescribe physiotherapy","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-15-qi-13","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" An electroneuromyogram is performed in this patient given the context of diabetes. The results are as follows: normal sensory and motor conduction velocities to all four limbs. The amplitude of the motor and sensory potentials is halved. The tracings in detection are in favor of neurogenic involvement. What syndromic diagnosis do you remember? (only one answer expected)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Axonal involvement","justification":""},{"idx":1,"correct":false,"proposition":"Demyelinating involvement","justification":""},{"idx":2,"correct":false,"proposition":"Myogenic involvement","justification":""},{"idx":3,"correct":false,"proposition":"Motor plate involvement","justification":""},{"idx":4,"correct":false,"proposition":"Anterior horn involvement","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-15-qi-14","context":"A 39-year-old patient comes to consult you. He has type I diabetes that began at the age of 11. It is treated with insulin. He works as an industrial draftsman, salaried. It reports discomfort to walking appeared 18 months ago and progressive worsening. He used to go for a weekly jog but now he just walks. He is sometimes bothered by his right leg which stumbles on the stairs and hangs at the end of a certain perimeter of step. On clinical examination, you will find an overall motor deficit of the right lower limb, hypoaesthesia of both feet and the lower right limb going up to the umbilicus as well as hypopallesthesia of both lower limbs. Patellar tendon reflexes are very sharp; They are normal to the upper limbs and the Achilean are abolished. The rest of the exam is normal.","enonce":" What medico-social measures should be put in place for this patient? (one or more correct answers)","item":"annales-2022-dp-15","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"MDPH file for applying for a mobility inclusion card","justification":""},{"idx":1,"correct":false,"proposition":"Invalidity second category","justification":""},{"idx":2,"correct":true,"proposition":"Application for ALD for MS","justification":""},{"idx":3,"correct":false,"proposition":"MDPH file for allocation of human aids","justification":""},{"idx":4,"correct":false,"proposition":"Outplacement","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-16-qi-1","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" The NFS finds: hemoglobin 10.5 g\/dL, MCV 70 fL, reticulocytes 10 G\/L. What is the most likely diagnosis?","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"non-regenerative microcytic anemia","justification":""},{"idx":1,"correct":false,"proposition":"regenerative microcytic anemia","justification":""},{"idx":2,"correct":false,"proposition":"regenerative macrocytic anemia","justification":""},{"idx":3,"correct":false,"proposition":"non-regenerative macrocytic anemia","justification":""},{"idx":4,"correct":false,"proposition":"normocytic regenerative anemia","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-16-qi-2","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" What proposals can explain this non-regenerative microcytic anemia? (one or more correct answers)","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"chronic hemolysis","justification":""},{"idx":1,"correct":false,"proposition":"Folate deficiency","justification":""},{"idx":2,"correct":true,"proposition":"Iron deficiency","justification":""},{"idx":3,"correct":true,"proposition":"celiac disease","justification":""},{"idx":4,"correct":true,"proposition":"Helicobacter pylori infection","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-16-qi-3","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" By plotting the staturo-weight curve, you notice an absence of weight gain for 3 months, without stature break in this young girl previously having a growth curve on the median in weight and height. What are the plausible diagnostic hypotheses? (one or more correct answers)","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"simple pubertal delay","justification":""},{"idx":1,"correct":false,"proposition":"growth hormone deficiency","justification":""},{"idx":2,"correct":true,"proposition":"celiac disease","justification":""},{"idx":3,"correct":true,"proposition":"Crohn's disease","justification":""},{"idx":4,"correct":false,"proposition":"hypothyroidism","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-16-qi-4","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" During interrogation, the mother finds that her daughter eats little at home and sorts her food. What element(s) is (are) in favor of a restrictive eating disorder?","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"relational impoverishment","justification":""},{"idx":1,"correct":true,"proposition":"physical hyperactivity","justification":""},{"idx":2,"correct":true,"proposition":"Concerns about his weight","justification":""},{"idx":3,"correct":false,"proposition":"Disinterest in schooling","justification":""},{"idx":4,"correct":true,"proposition":"wish to eat << healthy>>","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-16-qi-5","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" School absenteeism is important. The girl says that in addition to fatigue, she often has headaches. What element(s) are you looking for in the interrogation that will make you mention secondary headaches?","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"occurrence with cough","justification":""},{"idx":1,"correct":false,"proposition":"occurred mainly on weekends","justification":""},{"idx":2,"correct":true,"proposition":"always occurred on the same side","justification":""},{"idx":3,"correct":true,"proposition":"morning vomiting","justification":""},{"idx":4,"correct":false,"proposition":"associated abdominal pain","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-16-qi-6","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" The headaches are bifrontal, lasting between 10 minutes and 2 hours, relieved with paracetamol that she has been taking about 2 times a month for more than a year. She is not bothered by noise or light. What can it be? One or more exact proposal(s)?","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"typical migraine without aura","justification":""},{"idx":1,"correct":false,"proposition":"Analgesic abuse","justification":""},{"idx":2,"correct":true,"proposition":"tension headaches","justification":""},{"idx":3,"correct":false,"proposition":"chronic migraine","justification":""},{"idx":4,"correct":false,"proposition":"bilateral frontal sinusitis","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-16-qi-7","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" On clinical examination, you notice a small breast bud with enlargement of the areola, the absence of pubic hair, it is not settled. Regarding pubertal development in this patient, which is the exact proposal(s)?","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Tanner Stadium is S2P0","justification":""},{"idx":1,"correct":false,"proposition":"Tanner stadium is S1P0","justification":""},{"idx":2,"correct":true,"proposition":"Tanner Stadium is S2P1","justification":""},{"idx":3,"correct":false,"proposition":"she has a delayed puberty","justification":""},{"idx":4,"correct":false,"proposition":"She has a thelarche premature","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-16-qi-8","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" In front of these persistent headaches, you have a brain MRI performed, the image of which is here. Which proposal(s) is the exact proposal(s)?","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"legend 1 corresponds to the stem of the pituitary gland","justification":""},{"idx":1,"correct":false,"proposition":"Legend 2 corresponds to the third ventricle","justification":""},{"idx":2,"correct":true,"proposition":"legend 3 corresponds to the corpus callosum","justification":""},{"idx":3,"correct":false,"proposition":"Legend 4 corresponds to the cerebellar vermis","justification":""},{"idx":4,"correct":true,"proposition":"Legend 5 corresponds to the sphenoid sinus","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-16-qi-9","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" Brain MRI is normal. The ingesta evaluated by the dietician are lower than the average energy requirement. What is the average energy requirement of a 12-year-old girl? (only one answer expected)","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"1200 kcal\/d","justification":""},{"idx":1,"correct":false,"proposition":"1700 kcal\/d","justification":""},{"idx":2,"correct":true,"proposition":"2200 kcal\/d","justification":""},{"idx":3,"correct":false,"proposition":"2700 kcal\/d","justification":""},{"idx":4,"correct":false,"proposition":"3200 kcal\/d","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-16-qi-10","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" In front of microcytic anemia and the absence of weight gain, you evoke celiac disease. Which proposal(s) is the exact proposal(s)?","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"you find the child too old to discuss this diagnosis","justification":""},{"idx":1,"correct":true,"proposition":"you prescribe an anti-transglutaminase IgA assay","justification":""},{"idx":2,"correct":false,"proposition":"you prescribe an anti-endomysium IgG test","justification":""},{"idx":3,"correct":false,"proposition":"you prescribe the anti-gliadin IgA test","justification":""},{"idx":4,"correct":false,"proposition":"you are doing a proof treatment excluding gluten","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-16-qi-11","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" The dosage of anti-transglutaminase IgA is not in favor of the diagnosis of celiac disease, you now evoke Crohn's disease.Which element(s) would be the element(s) to look for in favor of this diagnostic hypothesis?","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Arthralgia","justification":""},{"idx":1,"correct":true,"proposition":"oral aphthosis","justification":""},{"idx":2,"correct":false,"proposition":"alopecia","justification":""},{"idx":3,"correct":false,"proposition":"episodes of hematemesis","justification":""},{"idx":4,"correct":true,"proposition":"erythema nodosum","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-16-qi-12","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" What would be the biological element(s) in favor of the diagnosis of Crohn's disease?","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Augmented CRP","justification":""},{"idx":1,"correct":true,"proposition":"hypoalbuminemia","justification":""},{"idx":2,"correct":false,"proposition":"increased fecal elastase","justification":""},{"idx":3,"correct":true,"proposition":"increased fecal calprotectin","justification":""},{"idx":4,"correct":false,"proposition":"positive anti-nuclear factors","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-16-qi-13","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" The diagnosis of Crohn's disease was ruled out in the absence of normal inflammatory syndrome, faecal calprotectin and albuminemia. You finally retain the diagnosis of isolated iron deficiency in front of a ferritinemia at 3 ng \/ mL.What element (s) do you seek at the interrogation to explain this disorder in this patient?","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"presence of menorrhagia","justification":""},{"idx":1,"correct":true,"proposition":"Replacement of meat products with pulses","justification":""},{"idx":2,"correct":false,"proposition":"insufficient consumption of oranges","justification":""},{"idx":3,"correct":false,"proposition":"intensive sports practice","justification":""},{"idx":4,"correct":false,"proposition":"excessive consumption of milk products","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-16-qi-14","context":"A 12-year-old girl is brought to the consultation by her mother who tells you that her daughter complains of being tired to the point that some days she does not go to school. She presents you with a recent complete blood count.","enonce":" She reports not consuming any meat products. Regarding martial supplementation, what is (are) the exact proposal(s)?","item":"annales-2022-dp-16","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"The initial prescription is preferably in injectable form","justification":""},{"idx":1,"correct":true,"proposition":"Treatment may result in black stool staining","justification":""},{"idx":2,"correct":true,"proposition":"It is best to divide the daily dose into 3 doses","justification":""},{"idx":3,"correct":true,"proposition":"A reticulocyte seizure usually occurs around day 10 of treatment","justification":""},{"idx":4,"correct":true,"proposition":"The duration of supplementation will be at least 3 months","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-18-qi-1","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" Which diagnosis is most likely? (only one answer expected)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Acute benzodiazepine poisoning","justification":""},{"idx":1,"correct":false,"proposition":"Acute amphetamine poisoning","justification":""},{"idx":2,"correct":true,"proposition":"Acute opioid poisoning","justification":""},{"idx":3,"correct":false,"proposition":"acute intoxication with antidepressants","justification":""},{"idx":4,"correct":false,"proposition":"acute lithium poisoning","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-18-qi-2","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" Which of the following is more suggestive of opioid poisoning?","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"pupillary examination","justification":""},{"idx":1,"correct":false,"proposition":"the depth of coma","justification":""},{"idx":2,"correct":false,"proposition":"Discovery on public roads","justification":""},{"idx":3,"correct":true,"proposition":"respiratory rate","justification":""},{"idx":4,"correct":false,"proposition":"temperature","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-18-qi-3","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" A coma by opioid overdose is diagnosed. What elements are part of the immediate drug treatment? (one or more correct answers)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Naloxone","justification":""},{"idx":1,"correct":false,"proposition":"Flumazenil","justification":""},{"idx":2,"correct":false,"proposition":"N-acetyl-cysteine","justification":""},{"idx":3,"correct":false,"proposition":"Atropine","justification":""},{"idx":4,"correct":false,"proposition":"Buprenorphine","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-18-qi-4","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" After a bolus of naloxone the patient wakes up, naloxone is kept in continuous infusion for a few hours. He reveals that he had bought 50 mg of methadone hydrochloride on the street where he has been living for 3 days, following his release from prison. He was incarcerated for a robbery. He doesn't understand what happened to him because, before entering prison two years ago, he had been taking 80 mg of methadone a day for several months. He was able to stop this treatment in prison, he says proudly: \"It was not easy, especially with the pain.\" But he admits to having \"plunged\" as soon as he left not having been able to control his desire for products. The health care team finds it a little odd. Which of the following elements of the observation are diagnostic criteria for opioid dependence? (one or more correct answers)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Robberies to obtain the product","justification":""},{"idx":1,"correct":true,"proposition":"Abdominal pain between doses","justification":""},{"idx":2,"correct":false,"proposition":"The episode of overdose","justification":""},{"idx":3,"correct":true,"proposition":"Consumption continues despite negative consequences","justification":""},{"idx":4,"correct":true,"proposition":"Craving","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-18-qi-5","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" To take stock of the social situation of this patient, what needs to be specified? (one or more correct answers)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"nationality","justification":""},{"idx":1,"correct":true,"proposition":"housing conditions","justification":""},{"idx":2,"correct":true,"proposition":"Health coverage","justification":""},{"idx":3,"correct":true,"proposition":"its resources and assistance","justification":""},{"idx":4,"correct":false,"proposition":"criminal record","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-18-qi-6","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" The patient is homeless. What options can be considered to relocate him? (one or more correct answers)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Hospitalization in psychiatry","justification":""},{"idx":1,"correct":false,"proposition":"Hospitalization in addictological follow-up care","justification":""},{"idx":2,"correct":true,"proposition":"Solicitation of a bed halte health care","justification":""},{"idx":3,"correct":false,"proposition":"Solicitation of a nursing home","justification":""},{"idx":4,"correct":true,"proposition":"Solicitation of associative hosting","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-18-qi-7","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" A few weeks later, the patient is housed in a Residential and Social Reintegration Centre (CHRS). He consults in addictology because \"decidedly, with heroin, it does not go anymore! \". He consumes 2 to 3 grams per day in sniffing or more rarely in injection. He went to see a doctor in town who advised him to withdraw or substitute treatment. Suspicious, he wants a second opinion on the resumption of methadone hydrochloride. Which of the following statements are true? (one or more correct answers)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"It is too risky given the history of overdose","justification":""},{"idx":1,"correct":false,"proposition":"It should be avoided in favor of clonidine withdrawal","justification":""},{"idx":2,"correct":true,"proposition":"It is possible with psychosocial support","justification":""},{"idx":3,"correct":false,"proposition":"It can be initiated by the town doctor","justification":""},{"idx":4,"correct":true,"proposition":"It is part of an overall risk reduction strategy","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-18-qi-8","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" The patient now lives with a 23-year-old woman, with whom he has been shopping for three months. She occasionally uses heroin sniffing and does not think she needs treatment. She regularly visits a centre where she is given information on the risk of overdose. Which of the following are appropriate risk and harm reduction strategies in this context? (one or more correct answers)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Condom distribution","justification":""},{"idx":1,"correct":true,"proposition":"The realization of serologies HIV, HVB, HVC","justification":""},{"idx":2,"correct":true,"proposition":"Recovery of used consumer equipment","justification":""},{"idx":3,"correct":true,"proposition":"Distribution of sterile syringes","justification":""},{"idx":4,"correct":false,"proposition":"Testing of products consumed","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-18-qi-9","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" The patient has been stabilized for 2 years by treatment with 80 mg of methadone hydrochloride per day. It is his attending physician who reproduces. Last week, he was on vacation and the patient had to deal with a replacement. He was questioned about his drinking, particularly alcohol and tobacco. The patient admitted to regularly drinking two to three beers every night. In order to reduce his cravings for alcohol, the patient asks if he could benefit from treatment like one of his friends who has managed to be weaned. What are the two molecules that could have been prescribed to his friend to help him reduce alcohol consumption?","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Nalmefene","justification":""},{"idx":1,"correct":false,"proposition":"Acamprosate","justification":""},{"idx":2,"correct":true,"proposition":"Baclofen","justification":""},{"idx":3,"correct":false,"proposition":"Naltrexone","justification":""},{"idx":4,"correct":false,"proposition":"Disulfiram","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-18-qi-10","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" The patient recalls that his friend received nalmefene treatment; He therefore wishes to obtain some. The patient's general practitioner's substitute explains the incompatibility of nalmefene with methadone, and offers acamprosate treatment after weaning. At the next consultation, the patient explains to his doctor that he thinks the replacement \"is in cahoots with the pharmaceutical industry\". He noted certain clues that support his idea. \"He would have done better to help me quit smoking,\" he told his doctor. He says he has smoked two packs a day for 10 years. He only supports cigarettes that he makes himself – \"It's safer,\" he says – and also the electronic cigarette. Which of the following signs of tobacco addiction is most severe? (only one answer expected)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"The need to smoke several times a day","justification":""},{"idx":1,"correct":false,"proposition":"Continued consumption despite negative consequences","justification":""},{"idx":2,"correct":true,"proposition":"Smoking your first cigarette when you wake up","justification":""},{"idx":3,"correct":false,"proposition":"Smoking rolled cigarettes","justification":""},{"idx":4,"correct":false,"proposition":"Denial of his smoking problem","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-18-qi-11","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" The patient is severely addicted to tobacco. He agrees to a treatment. Which treatments have a marketing authorization in this indication? (one or more correct answers)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Nicotine replacement by patch","justification":""},{"idx":1,"correct":true,"proposition":"nicotine replacement by gum","justification":""},{"idx":2,"correct":true,"proposition":"varenicline","justification":""},{"idx":3,"correct":false,"proposition":"Baclofen","justification":""},{"idx":4,"correct":false,"proposition":"e-cigarettes","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-18-qi-12","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" Two years later, the patient presented to the emergency room of the hospital because he was not feeling well. He has now been living alone for several months. He has not resumed heroin and is still taking methadone hydrochloride treatment. His partner left him because she could no longer stand his << laziness >> and his lack of motivation to do the markets. She also blamed him for his lack of emotions. He is not well, according to him, since a doctor finally acceded to his request for nalmefene, which he did not support. He often repeats \"evil is not fun\" with a knowing tune and sometimes fabricates new words. He doesn't see anyone anymore. He has trouble washing. Which psychiatric syndrome dominates this clinical picture? (only one answer expected)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"A depressive syndrome","justification":""},{"idx":1,"correct":false,"proposition":"Korsakoff's syndrome","justification":""},{"idx":2,"correct":true,"proposition":"A negative syndrome in schizophrenia","justification":""},{"idx":3,"correct":false,"proposition":"A positive syndrome in schizophrenia","justification":""},{"idx":4,"correct":false,"proposition":"A syndrome of disorganization in the context of schizophrenia","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-18-qi-13","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" The picture is mainly dominated by a negative syndrome suggestive of a schizophrenic disorder. What semiological elements are in favor of this syndrome? (one or more correct answers)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":false,"proposition":"Sadness","justification":""},{"idx":1,"correct":true,"proposition":"Emotional blunting","justification":""},{"idx":2,"correct":true,"proposition":"Aboulia","justification":""},{"idx":3,"correct":true,"proposition":"Social withdrawal","justification":""},{"idx":4,"correct":false,"proposition":"Neologism","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-18-qi-14","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" The patient claims that \"he was very harmed.\" He doesn't know who but he has researched the internet and knows \"now what really happened, and everything is connected\". He pauses in his speech and does not finish his sentences, but does not wish to say more because one could hear him and take it at him. In front of this clinical picture evolving for more than 6 months and the entire history of the patient we can conclude to a diagnosis of schizophrenia. What elements in favor of this diagnosis are in the observation? (one or more correct answers)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"Dams","justification":""},{"idx":1,"correct":true,"proposition":"Delusions","justification":""},{"idx":2,"correct":false,"proposition":"Acoustico-verbal hallucinations","justification":""},{"idx":3,"correct":false,"proposition":"Ideo-affective discordance","justification":""},{"idx":4,"correct":false,"proposition":"Catatonic syndrome","justification":""}],"type":"dp"}
+{"_id":"annales-2022-dp-18-qi-15","context":"A 25-year-old man is being treated on the public highway in a state of stuporous coma. It was his squat partners who alerted the emergency services. The vital parameters are: heart rate 60\/min, blood pressure 130\/80 mmHg, respiratory rate 10\/min. The summary clinical examination reveals bilateral miosis, decreased osteotendinous reflexes in all 4 limbs, an indifferent cutaneous-plantar reflex. Temperature is 35.6°C, capillary blood glucose is 6 mmol\/L and capillary oxygen saturation is 92%.","enonce":" The patient agrees to take treatment. Which of the following proposals apply to the antipsychotic treatment you are going to offer this patient? (one or more correct answers)","item":"annales-2022-dp-18","matiere":"annales-2022","propositions":[{"idx":0,"correct":true,"proposition":"it must be based on a second-generation antipsychotic","justification":""},{"idx":1,"correct":false,"proposition":"It must be combined with an anticholinergic corrector","justification":""},{"idx":2,"correct":false,"proposition":"  It must be prescribed in delayed injectable form","justification":""},{"idx":3,"correct":false,"proposition":"it must have a sedative component","justification":""},{"idx":4,"correct":true,"proposition":"It must be prescribed after analysis of an electrocardiogram","justification":""}],"type":"dp"}